Provider Demographics
NPI:1144093683
Name:RYAN, KRISTEN (LPC)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:RYAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 RIVERSIDE DR
Mailing Address - Street 2:
Mailing Address - City:RUMSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07760-1048
Mailing Address - Country:US
Mailing Address - Phone:908-868-3300
Mailing Address - Fax:
Practice Address - Street 1:16 RIVERSIDE DR
Practice Address - Street 2:
Practice Address - City:RUMSON
Practice Address - State:NJ
Practice Address - Zip Code:07760-1048
Practice Address - Country:US
Practice Address - Phone:908-868-3300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00987900101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional