Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | PC1835 | NJ |
NPI | 1003376377 |
---|---|
Provider Name | Carleton I Ryder |
First Address | Manalapan, NJ 07726 |
Second Address | Manalapan, NJ 07726 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2019 |
Last Update Date | 22/03/2019 |