Provider Demographics
NPI:1366673782
Name:RITCHEY, BRYAN KEITH (PSYD)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:KEITH
Last Name:RITCHEY
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 BANCROFT WAY SPC 4300
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94720-4304
Mailing Address - Country:US
Mailing Address - Phone:954-873-2464
Mailing Address - Fax:
Practice Address - Street 1:2222 BANCROFT WAY SPC 4300
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94720-4304
Practice Address - Country:US
Practice Address - Phone:954-873-2464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-03
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH8849101YM0800X
103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health