Provider Demographics
NPI:1386891786
Name:RYAN L CLEMENTS PSY.D. LLC
Entity type:Organization
Organization Name:RYAN L CLEMENTS PSY.D. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CLEMENTS
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:631-626-4459
Mailing Address - Street 1:1099 N COUNTRY RD
Mailing Address - Street 2:UNIT L
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-1924
Mailing Address - Country:US
Mailing Address - Phone:631-941-2210
Mailing Address - Fax:
Practice Address - Street 1:1099 N COUNTRY RD
Practice Address - Street 2:UNIT L
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11790-1924
Practice Address - Country:US
Practice Address - Phone:631-941-2210
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-27
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016820261QM0801X, 261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health