Provider Demographics
NPI:1154949022
Name:FAY, RYAN
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:FAY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1018 N BETHLEHEM PIKE STE 203
Mailing Address - Street 2:
Mailing Address - City:AMBLER
Mailing Address - State:PA
Mailing Address - Zip Code:19002-2107
Mailing Address - Country:US
Mailing Address - Phone:347-236-1068
Mailing Address - Fax:
Practice Address - Street 1:1018 N BETHLEHEM PIKE
Practice Address - Street 2:
Practice Address - City:LOWER GWYNEDD
Practice Address - State:PA
Practice Address - Zip Code:19002-2186
Practice Address - Country:US
Practice Address - Phone:347-236-1068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-08
Last Update Date:2021-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health