Provider Demographics
NPI:1134998925
Name:KERIVAN, BENJAMIN WARREN
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:WARREN
Last Name:KERIVAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:271 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:MEDFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02052-3108
Mailing Address - Country:US
Mailing Address - Phone:508-808-5882
Mailing Address - Fax:
Practice Address - Street 1:271 SOUTH ST
Practice Address - Street 2:
Practice Address - City:MEDFIELD
Practice Address - State:MA
Practice Address - Zip Code:02052-3108
Practice Address - Country:US
Practice Address - Phone:508-808-5882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-21
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer