Provider Demographics
NPI:1801558192
Name:NOEL, RYAN (PSYD)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:
Last Name:NOEL
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 DOUGHTY FARM RD
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:ME
Mailing Address - Zip Code:04039-9301
Mailing Address - Country:US
Mailing Address - Phone:415-926-9168
Mailing Address - Fax:
Practice Address - Street 1:257 DEERING AVE STE 201
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103-4858
Practice Address - Country:US
Practice Address - Phone:207-910-2021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-13
Last Update Date:2024-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS2463103TC0700X
VT048.0134278103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical