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General NPI Number Information
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NPI Number | 1073139168
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Entity Type | Individual
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Provider Name | RYAN CHARLES WARNER PH.D., CRC
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Gender | Male
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Dates
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Enumeration Date | 06/24/2020
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Last Update Date | 06/25/2020
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Provider Practice Location Address
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Address Line | 1501 SAN PEDRO DR SE
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City | ALBUQUERQUE
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State | NM
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Zip | 87108-5180
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Country | US
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Telephone | 505-846-3305
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Fax |
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Provider Business Mailing Address
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Address Line | 735A SILVERBERRY CIR SE
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City | ALBUQUERQUE
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State | NM
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Zip | 87116-3108
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Country | US
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Telephone | 708-925-7719
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 0810006905
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License Number State | VA
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