Provider Demographics
NPI:1598884231
Name:RYAN, VICTORIA (LMFT)
Entity type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:
Last Name:RYAN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 CAMINO DEL VALLE
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94502
Mailing Address - Country:US
Mailing Address - Phone:510-521-6454
Mailing Address - Fax:
Practice Address - Street 1:1900 EMBARCADERO
Practice Address - Street 2:SUITE 208
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94606
Practice Address - Country:US
Practice Address - Phone:510-346-1045
Practice Address - Fax:510-346-1083
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC35596101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA101YP2500XOtherPSYCHOTHERAPIST