Provider Demographics
NPI:1649590522
Name:RYAN, BRIGID S (MFT)
Entity Type:Individual
Prefix:
First Name:BRIGID
Middle Name:S
Last Name:RYAN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4525 MONTGOMERY DR
Mailing Address - Street 2:STE 14
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95409
Mailing Address - Country:US
Mailing Address - Phone:707-327-0244
Mailing Address - Fax:
Practice Address - Street 1:4525 MONTGOMERY DR
Practice Address - Street 2:STE 14
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95409
Practice Address - Country:US
Practice Address - Phone:707-327-0244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-02
Last Update Date:2019-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC43260106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist