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General NPI Number Information
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NPI Number | 1336031269
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Entity Type | Individual
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Provider Name | RYAN BEVERIDGE PH.D.
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Gender | Male
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Dates
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Enumeration Date | 07/16/2025
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Last Update Date | 07/16/2025
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Provider Practice Location Address
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Address Line | 100 DISCOVERY BLVD. ICMH, STAR TOWER, 6TH FLOOR
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City | NEWARK
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State | DE
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Zip | 19713
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Country | US
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Telephone | 302-831-2717
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Fax |
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Provider Business Mailing Address
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Address Line | 1034 SAINT GEORGES LN
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City | LANDENBERG
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State | PA
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Zip | 19350-1320
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Country | US
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Telephone | 801-502-6673
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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 | B1-0000862
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License Number State | DE
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