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General NPI Number Information
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NPI Number | 1285271536
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Entity Type | Individual
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Provider Name | MATTHEW RYAN VAN PSY.D.
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Gender | Male
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Dates
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Enumeration Date | 12/05/2019
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Last Update Date | 03/21/2025
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Provider Practice Location Address
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Address Line | 4904 WATERS EDGE DR STE 260
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City | RALEIGH
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State | NC
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Zip | 27606-8162
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Country | US
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Telephone | 919-322-9554
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Fax |
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Provider Business Mailing Address
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Address Line | 409 BOLIN CT
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City | RALEIGH
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State | NC
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Zip | 27603-2274
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Country | US
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Telephone | 318-267-6991
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 6437
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License Number State | NC
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