Provider Demographics
NPI:1467710285
Name:LENAHAN, RYAN JOHN
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:JOHN
Last Name:LENAHAN
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 1:1448 YOUNG ST APT 1208
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96814-1861
Mailing Address - Country:US
Mailing Address - Phone:723-773-6406
Mailing Address - Fax:
Practice Address - Street 1:1448 YOUNG ST APT 1208
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-1861
Practice Address - Country:US
Practice Address - Phone:723-773-6406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-30
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1-19-35966103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst