Healthcare Provider Details

I. General information

NPI: 1659496313
Provider Name (Legal Business Name): RYAN EMILY LUCASH PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RYAN EMILY FUSSELL PH.D.

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 10/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 WELCH RD DEVELOPMENTAL-BEHAVIORAL PEDIATRICS OFFICE
PALO ALTO CA
94304-1507
US

IV. Provider business mailing address

750 WELCH RD DEVELOPMENTAL-BEHAVIORAL PEDIATRICS OFFICE
PALO ALTO CA
94304-1507
US

V. Phone/Fax

Practice location:
  • Phone: 650-725-8995
  • Fax:
Mailing address:
  • Phone: 650-725-8995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY25960
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: