Individual
DR. CAROLYN RYAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHDLICMPHILMABCBAD
Contact information
Practice address
7822 CLOVERDALE BLVD, UNIT B, BAYSIDE, NY 11364-3124
(917) 335-2881
Mailing address
78-22 CLOVERDALE BLVD, UNIT B, BAYSIDE, NY 11364
(917) 335-2881
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
000048-1
NY
103T00000X
Psychologist
Primary
018669-1
NY
Other
Enumeration date
08/28/2015
Last updated
08/28/2015
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