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NPI Code Detail

MEDICARE: DR. ELIZABETH RYAN PH.D.

MEDICARE: DR. ELIZABETH RYAN PH.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
1103TC0700XClinical Psychologist10289MA

General Provider Information

NPI Number : 1609276617
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ELIZABETH RYAN PH.D.
Provider Business Mailing Address
First Line : 831 BEACON ST # 202
Second Line :
City : NEWTON
State : MA
Zip : 02459-1822
Country : US
Telephone Number : 617-870-6554
Fax Number :
Provider Business Practice Location Address
First Line : 2834 COLORADO AVE
Second Line :
City : SANTA MONICA
State : CA
Zip : 90404-3631
Country : US
Telephone Number : 617-870-6554
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/27/2014
Last Update Date : 10/02/2023

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