Healthcare Provider Details

I. General information

NPI: 1376712109
Provider Name (Legal Business Name): DAVID WINFIELD RYDER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2008
Last Update Date: 02/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 BOLTON PL
BROCKTON MA
02301-5316
US

IV. Provider business mailing address

15 BOLTON PL
BROCKTON MA
02301-5316
US

V. Phone/Fax

Practice location:
  • Phone: 508-427-4383
  • Fax: 508-584-4328
Mailing address:
  • Phone: 508-427-4383
  • Fax: 508-584-4328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: