Provider Demographics
NPI:1609597806
Name:PAGE, GARY RYAN (MA)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:RYAN
Last Name:PAGE
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 MOCKINGBIRD LN STE 580
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-1171
Mailing Address - Country:US
Mailing Address - Phone:704-910-8381
Mailing Address - Fax:704-981-8282
Practice Address - Street 1:1515 MOCKINGBIRD LN STE 580
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28209-1171
Practice Address - Country:US
Practice Address - Phone:704-910-8381
Practice Address - Fax:704-981-8282
Is Sole Proprietor?:No
Enumeration Date:2022-09-06
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist