Provider Demographics
NPI:1487113874
Name:REDDIN, RYAN A (PSYD)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:A
Last Name:REDDIN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 E HALSEY RD STE 356
Mailing Address - Street 2:
Mailing Address - City:PARSIPPANY
Mailing Address - State:NJ
Mailing Address - Zip Code:07054-3709
Mailing Address - Country:US
Mailing Address - Phone:973-327-3366
Mailing Address - Fax:973-201-6630
Practice Address - Street 1:90 E HALSEY RD STE 356
Practice Address - Street 2:
Practice Address - City:PARSIPPANY
Practice Address - State:NJ
Practice Address - Zip Code:07054-3709
Practice Address - Country:US
Practice Address - Phone:973-327-3366
Practice Address - Fax:973-201-6630
Is Sole Proprietor?:No
Enumeration Date:2019-03-15
Last Update Date:2019-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00616100103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1487113874Medicaid