Provider Demographics
NPI:1851015481
Name:GAGE, BENJAMIN F I (AMFT)
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:F
Last Name:GAGE
Suffix:I
Gender:M
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10767 ROSE AVE APT 31
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-4423
Mailing Address - Country:US
Mailing Address - Phone:818-458-9324
Mailing Address - Fax:
Practice Address - Street 1:23504 LYONS AVE STE 402B
Practice Address - Street 2:
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91321-5777
Practice Address - Country:US
Practice Address - Phone:818-458-9324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-27
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty