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NPI Code Detail

MEDICARE: RYAN EITNER

MEDICARE:   RYAN  EITNER
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
1101YM0800XMental Health CounselorMA

General Provider Information

NPI Number : 1871425157
Entity Type Code : Individual
Provider Name (Legal Business Name) : RYAN EITNER
Provider Business Mailing Address
First Line : 155 I ST
Second Line :
City : SOUTH BOSTON
State : MA
Zip : 02127-4060
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 81 HARTWELL AVE STE 310
Second Line :
City : LEXINGTON
State : MA
Zip : 02421-3177
Country : US
Telephone Number : 781-918-6869
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/01/2026
Last Update Date : 06/01/2026

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Directions to “ RYAN EITNER ” Practice Location

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