Healthcare Provider Details

I. General information

NPI: 1255124103
Provider Name (Legal Business Name): CARRIE RYBA, LCPC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2025
Last Update Date: 05/23/2025
Certification Date: 05/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 ANDERSON ST FL 2
PORTLAND ME
04101-2596
US

IV. Provider business mailing address

402 MOUNTFORT RD
NORTH YARMOUTH ME
04097-6926
US

V. Phone/Fax

Practice location:
  • Phone: 207-200-6208
  • Fax:
Mailing address:
  • Phone: 207-221-5247
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: CARRIE RYBA
Title or Position: MENTAL HEALTH COUNSELOR
Credential: LCPC
Phone: 207-200-6208