Provider Demographics
NPI:1306864319
Name:GARRITY, RYAN
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:
Last Name:GARRITY
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 1:28 PONTIAC RD
Mailing Address - Street 2:
Mailing Address - City:WALPOLE
Mailing Address - State:MA
Mailing Address - Zip Code:02081-4255
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:180 MASSACHUSETTS AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02474-8448
Practice Address - Country:US
Practice Address - Phone:339-707-6041
Practice Address - Fax:339-707-6726
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7977103G00000X
RIPS00771103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW06150OtherBLUE CROSS/BS OF MA
MAW06150OtherBLUE CROSS/BS OF MA