Provider Demographics
NPI:1124329222
Name:DELVECCHIO, RYAN LOU (LLP)
Entity type:Individual
Prefix:MR
First Name:RYAN
Middle Name:LOU
Last Name:DELVECCHIO
Suffix:
Gender:M
Credentials:LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9584 CAVELL ST
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48150-3220
Mailing Address - Country:US
Mailing Address - Phone:734-564-6402
Mailing Address - Fax:
Practice Address - Street 1:409 PLYMOUTH RD
Practice Address - Street 2:SUITE 100
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-1497
Practice Address - Country:US
Practice Address - Phone:734-927-1201
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-06
Last Update Date:2010-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301014025101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor