MEDICARE: CAROLINE RYAN BCBA, MS

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	103K00000X	Behavior Analyst	1-16-22683	NJ

General Provider Information

NPI Number	:	1528561529
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLINE RYAN BCBA, MS

Provider Business Mailing Address
First Line	:	88 S LAKEVIEW DR
Second Line	:
City	:	GIBBSBORO
State	:	NJ
Zip	:	08026-1229
Country	:	US
Telephone Number	:	856-484-5535
Fax Number	:

Provider Business Practice Location Address
First Line	:	88 S LAKEVIEW DR
Second Line	:
City	:	GIBBSBORO
State	:	NJ
Zip	:	08026-1229
Country	:	US
Telephone Number	:	856-484-5535
Fax Number	:

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

Provider Enumeration Date	:	03/15/2018
Last Update Date	:	07/31/2024

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