Healthcare Provider Details

I. General information

NPI: 1306864319
Provider Name (Legal Business Name): DR. RYAN GARRITY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 MASSACHUSETTS AVE SUITE 302
ARLINGTON MA
02474-8448
US

IV. Provider business mailing address

28 PONTIAC RD
WALPOLE MA
02081-4255
US

V. Phone/Fax

Practice location:
  • Phone: 339-707-6041
  • Fax: 339-707-6726
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number7977
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPS00771
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: