Provider Demographics
NPI:1609643394
Name:BERENA, RYLAN VINCE
Entity Type:Individual
Prefix:
First Name:RYLAN VINCE
Middle Name:
Last Name:BERENA
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 1:44 CENTER GROVE RD APT Q-26
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:NJ
Mailing Address - Zip Code:07869-4492
Mailing Address - Country:US
Mailing Address - Phone:916-343-0089
Mailing Address - Fax:
Practice Address - Street 1:44 CENTER GROVE RD APT Q-26
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:NJ
Practice Address - Zip Code:07869-4492
Practice Address - Country:US
Practice Address - Phone:916-343-0089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst