Provider Demographics
NPI:1477105682
Name:HARTLEY, RYAN DAVID (LBA,BCBA)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:DAVID
Last Name:HARTLEY
Suffix:
Gender:M
Credentials:LBA,BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 W NATICK RD STE 400
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-1161
Mailing Address - Country:US
Mailing Address - Phone:401-826-8875
Mailing Address - Fax:401-826-8926
Practice Address - Street 1:275 W NATICK RD STE 400
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-1161
Practice Address - Country:US
Practice Address - Phone:401-826-8875
Practice Address - Fax:401-826-8926
Is Sole Proprietor?:No
Enumeration Date:2019-07-09
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
RILBA00385103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician