Provider Demographics
NPI:1114099603
Name:RYER, GLENN WILLIAM (PHD)
Entity Type:Individual
Prefix:MR
First Name:GLENN
Middle Name:WILLIAM
Last Name:RYER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 SHADY HILL DR
Mailing Address - Street 2:
Mailing Address - City:CHALFONT
Mailing Address - State:PA
Mailing Address - Zip Code:18914-2028
Mailing Address - Country:US
Mailing Address - Phone:215-676-8404
Mailing Address - Fax:
Practice Address - Street 1:104 SHADY HILL DR
Practice Address - Street 2:
Practice Address - City:CHALFONT
Practice Address - State:PA
Practice Address - Zip Code:18914-2028
Practice Address - Country:US
Practice Address - Phone:215-676-8404
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS003956L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1018305480001Medicaid
PA1018305480001Medicaid