Provider Demographics
NPI:1588707731
Name:PICKRELL, RYAN JOSHUA (MSW)
Entity type:Individual
Prefix:MR
First Name:RYAN
Middle Name:JOSHUA
Last Name:PICKRELL
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 SKYVIEW TER
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-1845
Mailing Address - Country:US
Mailing Address - Phone:415-491-0708
Mailing Address - Fax:415-472-7140
Practice Address - Street 1:70 SKYVIEW TER
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-1845
Practice Address - Country:US
Practice Address - Phone:415-491-0708
Practice Address - Fax:415-472-7140
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker