Provider Demographics
NPI:1467112441
Name:HINDERLITER, RYAN (BCABA)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:
Last Name:HINDERLITER
Suffix:
Gender:M
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5459 PICKEREL WAY
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-2525
Mailing Address - Country:US
Mailing Address - Phone:908-514-2212
Mailing Address - Fax:
Practice Address - Street 1:5459 PICKEREL WAY
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34232-2525
Practice Address - Country:US
Practice Address - Phone:908-514-2212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-18
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
FL106S00000X
FL0-24-14970106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician