Provider Demographics
NPI:1013647288
Name:RYDER, DOROTHY JADA
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:JADA
Last Name:RYDER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 BROOKSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10553-1304
Mailing Address - Country:US
Mailing Address - Phone:646-663-0117
Mailing Address - Fax:
Practice Address - Street 1:132 BROOKSIDE AVE
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10553-1304
Practice Address - Country:US
Practice Address - Phone:646-663-0117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-12
Last Update Date:2022-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst