Provider Demographics
NPI:1760924328
Name:CROCHIERE, RYAN KELLETT (MFT)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:KELLETT
Last Name:CROCHIERE
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 DANA ST
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705-2041
Mailing Address - Country:US
Mailing Address - Phone:415-255-2519
Mailing Address - Fax:
Practice Address - Street 1:3001 DANA ST
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-2041
Practice Address - Country:US
Practice Address - Phone:415-255-2519
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-14
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA91240106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist