MEDICARE: LAURA THERESA RYAN

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		NY

General Provider Information

NPI Number	:	1972322287
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA THERESA RYAN

Provider Business Mailing Address
First Line	:	4 DONLO DR APT 4
Second Line	:
City	:	FISHKILL
State	:	NY
Zip	:	12524-2659
Country	:	US
Telephone Number	:	843-424-4729
Fax Number	:

Provider Business Practice Location Address
First Line	:	2 HALDANE ST
Second Line	:
City	:	COLD SPRING
State	:	NY
Zip	:	10516-2820
Country	:	US
Telephone Number	:	347-563-3691
Fax Number	:

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

Provider Enumeration Date	:	10/04/2024
Last Update Date	:	10/04/2024

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