Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 4342 | MA |
N | 103T00000X | Psychologist | 4342 | MA |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | ||
N | 103TA0700X | Adult Development & Aging Psychologist | ||
N | 103TC1900X | Counseling Psychologist |
NPI | 1306885652 |
---|---|
Provider Name | Elizabeth M Ryan |
First Address | Plymouth, MA 02360-4829 |
Second Address | Plymouth, MA 02360-4829 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
004343 | TUFTS HEALTH PLAN (01) | MA |