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General NPI Number Information
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NPI Number | 1164702759
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Entity Type | Individual
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Provider Name | JULIE LYNN RYAN PH.D.
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Gender | Female
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Dates
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Enumeration Date | 08/26/2011
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Last Update Date | 08/26/2011
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Provider Practice Location Address
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Address Line | 156 5TH AVE SUITE 718
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City | NEW YORK
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State | NY
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Zip | 10010-7002
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Country | US
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Telephone | 617-308-8739
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Fax | 201-692-2304
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Provider Business Mailing Address
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Address Line | 225 HALLADAY ST UNIT 1
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City | JERSEY CITY
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State | NJ
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Zip | 07304-3327
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Country | US
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Telephone | 617-308-8739
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Fax | 201-692-2304
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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 | 019175-1
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License Number State | NY
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