Provider Demographics
NPI:1932962578
Name:DOOLEY, RYAN
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:DOOLEY
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 1:3630 HIGH STREET
Mailing Address - Street 2:P.O. BOX 18530
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94619
Mailing Address - Country:US
Mailing Address - Phone:510-394-2220
Mailing Address - Fax:
Practice Address - Street 1:2873 MISSION ST STE 10
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94110-3907
Practice Address - Country:US
Practice Address - Phone:510-394-2220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA143421106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist