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NPI Code Detail

MEDICARE: JOAN M RYAN PSYCHOLOGIST- SCHOOL

MEDICARE: JOAN M RYAN PSYCHOLOGIST- SCHOOL
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TS0200XSchool Psychologist49857NH

General Provider Information

NPI Number : 1104438175
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOAN M RYAN PSYCHOLOGIST- SCHOOL
Provider Business Mailing Address
First Line : PO BOX 1274
Second Line :
City : BERWICK
State : ME
Zip : 03901-1274
Country : US
Telephone Number : 207-698-7102
Fax Number :
Provider Business Practice Location Address
First Line : 22 ROLLER COASTER RD
Second Line :
City : STRAFFORD
State : NH
Zip : 03884-6648
Country : US
Telephone Number : 603-664-2842
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/20/2020
Last Update Date : 08/20/2020

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