Provider Demographics
NPI:1669856480
Name:RYAN, ROBERT (LPC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:RYAN
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5180 CAMPBELLS RUN RD
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15205-9731
Mailing Address - Country:US
Mailing Address - Phone:412-788-8219
Mailing Address - Fax:412-788-8215
Practice Address - Street 1:5180 CAMPBELLS RUN RD
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15205-9731
Practice Address - Country:US
Practice Address - Phone:412-788-8219
Practice Address - Fax:412-788-8215
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-10
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC008285101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional