Provider Demographics
NPI:1396959656
Name:RYAN, PATRICIA MCDONOUGH (PHD)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:MCDONOUGH
Last Name:RYAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:PATRICIA
Other - Middle Name:MCDONOUGH
Other - Last Name:RYAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:7 JUNIPER RD
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:CT
Mailing Address - Zip Code:06820-5707
Mailing Address - Country:US
Mailing Address - Phone:513-608-0135
Mailing Address - Fax:
Practice Address - Street 1:85 OLD KINGS HWY N
Practice Address - Street 2:CONCUSSION CENTER OF FAIRFIELD COUNTY
Practice Address - City:DARIEN
Practice Address - State:CT
Practice Address - Zip Code:06820-4732
Practice Address - Country:US
Practice Address - Phone:513-608-0135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003067103G00000X
OH6069103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist