Provider Demographics
NPI:1821237389
Name:RIDGEWAY, REUBEN BENJAMIN (PHD)
Entity Type:Individual
Prefix:DR
First Name:REUBEN
Middle Name:BENJAMIN
Last Name:RIDGEWAY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:490 BREWTON ST
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29115-4218
Mailing Address - Country:US
Mailing Address - Phone:803-707-3634
Mailing Address - Fax:
Practice Address - Street 1:1175 COOK RD STE 305
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29118-8247
Practice Address - Country:US
Practice Address - Phone:803-395-3715
Practice Address - Fax:803-395-3719
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-06
Last Update Date:2023-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1092103TC0700X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical