Provider Demographics
NPI:1104438175
Name:RYAN, JOAN M (PSYCHOLOGIST- SCHOOL)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:M
Last Name:RYAN
Suffix:
Gender:F
Credentials:PSYCHOLOGIST- SCHOOL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1274
Mailing Address - Street 2:
Mailing Address - City:BERWICK
Mailing Address - State:ME
Mailing Address - Zip Code:03901-1274
Mailing Address - Country:US
Mailing Address - Phone:207-698-7102
Mailing Address - Fax:
Practice Address - Street 1:22 ROLLER COASTER RD
Practice Address - Street 2:
Practice Address - City:STRAFFORD
Practice Address - State:NH
Practice Address - Zip Code:03884-6648
Practice Address - Country:US
Practice Address - Phone:603-664-2842
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-20
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH49857103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool