Healthcare Provider Details

I. General information

NPI: 1619246147
Provider Name (Legal Business Name): RYAN G MONTANARI PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/29/2011
Last Update Date: 06/20/2025
Certification Date: 06/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 MDG / RAF LAKENHEATH, UNIT 5115,
APO AE
09461
US

IV. Provider business mailing address

48 MDG / RAF LAKENHEATH, UNIT 5115,
APO AE
09461
US

V. Phone/Fax

Practice location:
  • Phone: 314-226-8010
  • Fax:
Mailing address:
  • Phone: 314-226-8010
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY29774
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: