Provider Demographics
NPI:1710765920
Name:CORL, RYAN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:RYAN
Middle Name:
Last Name:CORL
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 1:1350 CONNECTICUT AVE NW STE 611
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20036-1764
Mailing Address - Country:US
Mailing Address - Phone:202-630-8120
Mailing Address - Fax:
Practice Address - Street 1:1350 CONNECTICUT AVE NW STE 611
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-1764
Practice Address - Country:US
Practice Address - Phone:202-630-8120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-19
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPSYA200001348103TC0700X
MD06913103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical