Healthcare Provider Details

I. General information

NPI: 1932454352
Provider Name (Legal Business Name): KATHERINE K. RYAN, PHD, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2012
Last Update Date: 10/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 WOODFORD ST
PORTLAND ME
04103-5617
US

IV. Provider business mailing address

251 WOODFORD ST
PORTLAND ME
04103-5617
US

V. Phone/Fax

Practice location:
  • Phone: 207-773-2828
  • Fax: 207-761-8150
Mailing address:
  • Phone: 207-773-2828
  • Fax: 207-761-8150

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number1334
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number1334
License Number StateME

VIII. Authorized Official

Name: KATHERINE K RYAN
Title or Position: OWNER/PSYCHOLOGIST
Credential: PH.D.
Phone: 508-284-1210