Provider Demographics
NPI:1952883878
Name:KAGEDAN, BENJAMIN URIEL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:URIEL
Last Name:KAGEDAN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3580 INDIAN QUEEN LN
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19129-1540
Mailing Address - Country:US
Mailing Address - Phone:201-280-1159
Mailing Address - Fax:
Practice Address - Street 1:3580 INDIAN QUEEN LN
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19129-1540
Practice Address - Country:US
Practice Address - Phone:201-280-1159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-06
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022830103TC0700X
PAPS019180103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty