Healthcare Provider Details

I. General information

NPI: 1013527159
Provider Name (Legal Business Name): PAUL RYAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2020
Last Update Date: 03/26/2025
Certification Date: 03/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

58 HIGH ST
TORRINGTON CT
06790-5106
US

IV. Provider business mailing address

23 BEACON ST
NEWINGTON CT
06111-4703
US

V. Phone/Fax

Practice location:
  • Phone: 860-496-2100
  • Fax: 860-496-2111
Mailing address:
  • Phone: 860-666-0786
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number004322
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: