Provider Demographics
NPI:1164836193
Name:MCGUCKIN, RYAN
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:MCGUCKIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 HADDONFIELD RD
Mailing Address - Street 2:SUITE 125
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08002-4813
Mailing Address - Country:US
Mailing Address - Phone:856-254-3800
Mailing Address - Fax:
Practice Address - Street 1:57 HADDONFIELD RD
Practice Address - Street 2:SUITE 125
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08002-4813
Practice Address - Country:US
Practice Address - Phone:856-254-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-18
Last Update Date:2014-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health