Provider Demographics
NPI:1942931183
Name:REDNER, RYAN (PHD)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:REDNER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 OX YOKE WAY
Mailing Address - Street 2:
Mailing Address - City:CARBONDALE
Mailing Address - State:IL
Mailing Address - Zip Code:62902-7511
Mailing Address - Country:US
Mailing Address - Phone:209-345-3743
Mailing Address - Fax:
Practice Address - Street 1:1776 AVENUE OF THE STATES STE 101A
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-4592
Practice Address - Country:US
Practice Address - Phone:732-730-0700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-20
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst