Provider Demographics
NPI:1588360465
Name:PINTER, MICHAEL RYAN (SSP)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:RYAN
Last Name:PINTER
Suffix:
Gender:M
Credentials:SSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12731 STONE TOWER LOOP
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33913-6768
Mailing Address - Country:US
Mailing Address - Phone:239-784-8283
Mailing Address - Fax:
Practice Address - Street 1:3333 RENAISSANCE BLVD STE 203
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134-7007
Practice Address - Country:US
Practice Address - Phone:239-784-8283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-02
Last Update Date:2023-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSS1731103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool