Provider Demographics
NPI:1306026885
Name:RYAN, MICHELLE L (MA, CAGS)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L
Last Name:RYAN
Suffix:
Gender:F
Credentials:MA, CAGS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:49 FARNUM PIKE
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02917-3211
Mailing Address - Country:US
Mailing Address - Phone:401-231-6606
Mailing Address - Fax:401-232-0870
Practice Address - Street 1:49 FARNUM PIKE
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:RI
Practice Address - Zip Code:02917-3211
Practice Address - Country:US
Practice Address - Phone:401-231-6606
Practice Address - Fax:401-232-0870
Is Sole Proprietor?:No
Enumeration Date:2007-11-13
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool