Provider Demographics
NPI:1336031269
Name:BEVERIDGE, RYAN (PHD)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:
Last Name:BEVERIDGE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1034 SAINT GEORGES LN
Mailing Address - Street 2:
Mailing Address - City:LANDENBERG
Mailing Address - State:PA
Mailing Address - Zip Code:19350-1320
Mailing Address - Country:US
Mailing Address - Phone:801-502-6673
Mailing Address - Fax:
Practice Address - Street 1:100 DISCOVERY BLVD.
Practice Address - Street 2:ICMH, STAR TOWER, 6TH FLOOR
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713
Practice Address - Country:US
Practice Address - Phone:302-831-2717
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-16
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEB1-0000862103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical