Provider Demographics
NPI:1730480658
Name:RAMOS, CRYSTAL KILLILEA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CRYSTAL
Middle Name:KILLILEA
Last Name:RAMOS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10293 N MERIDIAN ST
Mailing Address - Street 2:STE 210
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46290-1079
Mailing Address - Country:US
Mailing Address - Phone:317-278-5859
Mailing Address - Fax:317-274-1248
Practice Address - Street 1:10293 N MERIDIAN ST STE 210
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46290-1079
Practice Address - Country:US
Practice Address - Phone:317-581-2292
Practice Address - Fax:317-581-2285
Is Sole Proprietor?:No
Enumeration Date:2010-11-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IN20042520A103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program