Healthcare Provider Details

I. General information

NPI: 1114748845
Provider Name (Legal Business Name): RYAN STICKEL M.A., C.A.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2024
Last Update Date: 10/24/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2644 RIVA ROAD
ANNAPOLIS MD
21401-7427
US

IV. Provider business mailing address

115 CHESSIE CT
CHESTER MD
21619-2669
US

V. Phone/Fax

Practice location:
  • Phone: 410-222-5000
  • Fax:
Mailing address:
  • Phone: 410-688-9795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: