Provider Demographics
NPI:1063567717
Name:RYAN, JEANNE PAULA (PHD)
Entity type:Individual
Prefix:DR
First Name:JEANNE
Middle Name:PAULA
Last Name:RYAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 PINE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:MORRISONVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:12962-9797
Mailing Address - Country:US
Mailing Address - Phone:518-420-4929
Mailing Address - Fax:518-563-6658
Practice Address - Street 1:39 COURT ST
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-2801
Practice Address - Country:US
Practice Address - Phone:518-536-0330
Practice Address - Fax:518-563-6658
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013297103G00000X, 103T00000X
013297103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist