Provider Demographics
NPI:1902607484
Name:MALONE, RYAN THOMAS (PSYD)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:THOMAS
Last Name:MALONE
Suffix:
Gender:
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4023 CHAIN BRIDGE ROAD
Mailing Address - Street 2:SUITE 7
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030
Mailing Address - Country:US
Mailing Address - Phone:571-380-8881
Mailing Address - Fax:
Practice Address - Street 1:4023 CHAIN BRIDGE RD
Practice Address - Street 2:STE 7
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-4121
Practice Address - Country:US
Practice Address - Phone:571-380-8881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-21
Last Update Date:2025-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810008549103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical