Healthcare Provider Details

I. General information

NPI: 1982395018
Provider Name (Legal Business Name): MR. RYAN JAMES WARNER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2023
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

82 WENDELL AVE STE 100
PITTSFIELD MA
01201-7066
US

IV. Provider business mailing address

82 WENDELL AVE STE 100
PITTSFIELD MA
01201-7066
US

V. Phone/Fax

Practice location:
  • Phone: 904-755-4425
  • Fax:
Mailing address:
  • Phone: 904-755-4425
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMHC10007207
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: