Provider Demographics
NPI:1780030221
Name:RYAN, TINA (BS)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:RYAN
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:
Other - Last Name:PASTORINI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS
Mailing Address - Street 1:171 ERIC DR
Mailing Address - Street 2:
Mailing Address - City:UXBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01569-1459
Mailing Address - Country:US
Mailing Address - Phone:904-962-6569
Mailing Address - Fax:
Practice Address - Street 1:171 ERIC DR
Practice Address - Street 2:
Practice Address - City:UXBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01569-1459
Practice Address - Country:US
Practice Address - Phone:904-962-6569
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-13
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health