Provider Demographics
NPI:1578269502
Name:RYAN, DEIRDRE BRIELLE (BS)
Entity Type:Individual
Prefix:
First Name:DEIRDRE
Middle Name:BRIELLE
Last Name:RYAN
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:TAUNTON
Mailing Address - State:MA
Mailing Address - Zip Code:02780-2777
Mailing Address - Country:US
Mailing Address - Phone:508-880-1598
Mailing Address - Fax:
Practice Address - Street 1:66 MAIN ST
Practice Address - Street 2:
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780-2777
Practice Address - Country:US
Practice Address - Phone:508-880-1598
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-01
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)