Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 04632 | MD |
Y | 103TC0700X | Clinical Psychologist | 04632 | MD |
N | 103G00000X | Clinical Psychologist | 04632 | MD |
N | 103TC0700X | Clinical Psychologist | 04632 | MD |
N | 103TR0400X | Rehabilitation Psychologist | 04632 | MD |
NPI | 1760524243 |
---|---|
Provider Name | Patricia Ryan |
First Address | Baltimore, MD 21201-1524 |
Second Address | Baltimore, MD 21201-1524 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/02/2007 |
Last Update Date | 17/01/2011 |