Provider Demographics
NPI:1427210525
Name:MONTMINY, RYAN ROBERT (MA,LADC)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:ROBERT
Last Name:MONTMINY
Suffix:
Gender:M
Credentials:MA,LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 WINTER ST
Mailing Address - Street 2:
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01830-5760
Mailing Address - Country:US
Mailing Address - Phone:978-373-1181
Mailing Address - Fax:978-374-7605
Practice Address - Street 1:76 WINTER ST
Practice Address - Street 2:
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01830-5760
Practice Address - Country:US
Practice Address - Phone:978-373-1181
Practice Address - Fax:978-374-7605
Is Sole Proprietor?:No
Enumeration Date:2008-06-30
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1587101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)