Provider Demographics
NPI:1649578766
Name:AYLWARD, RYAN C (PSYD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:C
Last Name:AYLWARD
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:234 BROADWAY STE 2
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-1947
Mailing Address - Country:US
Mailing Address - Phone:617-758-8485
Mailing Address - Fax:
Practice Address - Street 1:234 BROADWAY STE 2
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-1947
Practice Address - Country:US
Practice Address - Phone:617-758-8485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-14
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9043103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist