Provider Demographics
NPI:1942333943
Name:RYAN, MAUREEN MICHELLE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MAUREEN
Middle Name:MICHELLE
Last Name:RYAN
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 1:415 MARBLEHEAD DR
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14615-1137
Mailing Address - Country:US
Mailing Address - Phone:585-730-8449
Mailing Address - Fax:
Practice Address - Street 1:3700 EAST AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14618-3527
Practice Address - Country:US
Practice Address - Phone:585-248-8740
Practice Address - Fax:585-248-8126
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013176-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical