Provider Demographics
NPI:1699470559
Name:OJEDA, RYAN (MA, LAC)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:OJEDA
Suffix:
Gender:M
Credentials:MA, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 FISHERS LN
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:NJ
Mailing Address - Zip Code:07871-2440
Mailing Address - Country:US
Mailing Address - Phone:973-671-8786
Mailing Address - Fax:973-726-0617
Practice Address - Street 1:9 FISHERS LN
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:NJ
Practice Address - Zip Code:07871-2440
Practice Address - Country:US
Practice Address - Phone:973-671-8786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-31
Last Update Date:2025-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00630300101YM0800X
NJ37PC01103000101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health