Provider Demographics
NPI:1881419745
Name:DRAKES, RYAN O'NEAL
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:O'NEAL
Last Name:DRAKES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3320 W 3RD ST
Mailing Address - Street 2:
Mailing Address - City:TRAINER
Mailing Address - State:PA
Mailing Address - Zip Code:19061-5106
Mailing Address - Country:US
Mailing Address - Phone:347-331-8862
Mailing Address - Fax:
Practice Address - Street 1:422 E 22ND ST
Practice Address - Street 2:
Practice Address - City:CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19013-5201
Practice Address - Country:US
Practice Address - Phone:215-832-0269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-16
Last Update Date:2024-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist