Provider Demographics
NPI:1407526395
Name:RONAN, CRAIG JOSEPH
Entity Type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:JOSEPH
Last Name:RONAN
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 1:51 KONDAZIAN ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-2830
Mailing Address - Country:US
Mailing Address - Phone:617-924-1285
Mailing Address - Fax:617-939-9714
Practice Address - Street 1:51 KONDAZIAN ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-2830
Practice Address - Country:US
Practice Address - Phone:617-924-1285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-14
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor