MEDICARE: DR. MARY KAY AEBLY-RYAN PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	012266-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P2045984	OTHER	NY	OXFORD PROVIDER ID

General Provider Information

NPI Number	:	1023167483
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY KAY AEBLY-RYAN PSY.D.

Provider Business Mailing Address
First Line	:	239 N BROADWAY
Second Line	:	SUITE 6
City	:	SLEEPY HOLLOW
State	:	NY
Zip	:	10591-2674
Country	:	US
Telephone Number	:	914-432-7752
Fax Number	:

Provider Business Practice Location Address
First Line	:	239 N BROADWAY
Second Line	:	SUITE 6
City	:	SLEEPY HOLLOW
State	:	NY
Zip	:	10591-2674
Country	:	US
Telephone Number	:	914-432-7752
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	02/01/2011

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