Healthcare Provider Details

I. General information

NPI: 1669856480
Provider Name (Legal Business Name): ROBERT RYAN LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2015
Last Update Date: 07/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5180 CAMPBELLS RUN RD
PITTSBURGH PA
15205-9731
US

IV. Provider business mailing address

5180 CAMPBELLS RUN RD
PITTSBURGH PA
15205-9731
US

V. Phone/Fax

Practice location:
  • Phone: 412-788-8219
  • Fax: 412-788-8215
Mailing address:
  • Phone: 412-788-8219
  • Fax: 412-788-8215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC008285
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: