Provider Demographics
NPI:1942363809
Name:RYAN, SUZAN JOHNSON (PH D)
Entity type:Individual
Prefix:
First Name:SUZAN
Middle Name:JOHNSON
Last Name:RYAN
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 ROSEHILL AVE
Mailing Address - Street 2:
Mailing Address - City:TARRYTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10591-4125
Mailing Address - Country:US
Mailing Address - Phone:914-631-2674
Mailing Address - Fax:914-631-2674
Practice Address - Street 1:16 ROSEHILL AVE
Practice Address - Street 2:
Practice Address - City:TARRYTOWN
Practice Address - State:NY
Practice Address - Zip Code:10591-4125
Practice Address - Country:US
Practice Address - Phone:914-631-2674
Practice Address - Fax:914-631-2674
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006160-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV47011Medicare ID - Type Unspecified