Healthcare Provider Details

I. General information

NPI: 1275862302
Provider Name (Legal Business Name): KERI RYAN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2009
Last Update Date: 11/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 KNOLLCROFT RD BUILDING 57
LYONS NJ
07939-5001
US

IV. Provider business mailing address

151 KNOLLCROFT RD BUILDING 57
LYONS NJ
07939-5001
US

V. Phone/Fax

Practice location:
  • Phone: 908-647-0180
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number017544
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: