Healthcare Provider Details

I. General information

NPI: 1629589932
Provider Name (Legal Business Name): RYAN JAY DOIG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2017
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 NOTTINGHAM ST
SPRINGFIELD MA
01104-2622
US

IV. Provider business mailing address

315 NOTTINGHAM ST
SPRINGFIELD MA
01104-2622
US

V. Phone/Fax

Practice location:
  • Phone: 413-419-9906
  • Fax:
Mailing address:
  • Phone: 413-419-9906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMHC5000264
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: