Healthcare Provider Details

I. General information

NPI: 1124958491
Provider Name (Legal Business Name): RYAN CLANCY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

960 YGNACIO VALLEY RD
WALNUT CREEK CA
94596-3826
US

IV. Provider business mailing address

960 YGNACIO VALLEY RD
WALNUT CREEK CA
94596-3826
US

V. Phone/Fax

Practice location:
  • Phone: 925-944-6850
  • Fax:
Mailing address:
  • Phone: 925-944-6850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number240251897
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: