Healthcare Provider Details

I. General information

NPI: 1306885652
Provider Name (Legal Business Name): ELIZABETH M RYAN ED.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 INDUSTRIAL PARK RD
PLYMOUTH MA
02360-4829
US

IV. Provider business mailing address

64 INDUSTRIAL PARK RD
PLYMOUTH MA
02360-4829
US

V. Phone/Fax

Practice location:
  • Phone: 508-830-9562
  • Fax: 508-830-6735
Mailing address:
  • Phone: 508-830-9562
  • Fax: 508-830-6735

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number4342
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: