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General NPI Number Information
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NPI Number | 1811405632
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Entity Type | Individual
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Provider Name | RYAN MOYLAN MS
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Gender | Male
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Dates
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Enumeration Date | 01/15/2018
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Last Update Date | 12/16/2021
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Provider Practice Location Address
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Address Line | 140 WOOD RD STE 206
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City | BRAINTREE
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State | MA
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Zip | 02184-2508
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Country | US
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Telephone | 978-222-3121
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Fax |
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Provider Business Mailing Address
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Address Line | 32 SASSAMON AVE
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City | MILTON
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State | MA
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Zip | 02186-5816
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Country | US
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Telephone | 781-964-1820
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 12757
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License Number State | MA
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