Provider Demographics
NPI:1538659750
Name:BERTONE, RYAN CHRISTOPHER I
Entity type:Individual
Prefix:MR
First Name:RYAN
Middle Name:CHRISTOPHER
Last Name:BERTONE
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 HAMPSTEAD WAY
Mailing Address - Street 2:
Mailing Address - City:MARSHFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02050-6236
Mailing Address - Country:US
Mailing Address - Phone:617-922-5369
Mailing Address - Fax:
Practice Address - Street 1:190 HAMPSTEAD WAY
Practice Address - Street 2:
Practice Address - City:MARSHFIELD
Practice Address - State:MA
Practice Address - Zip Code:02050-6236
Practice Address - Country:US
Practice Address - Phone:617-922-5369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-14
Last Update Date:2018-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician