| Organization Name: | BLUE RIDGE NEUROPSYCHOLOGY |
| NPI Number: | 1104287168 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | THOMAS V RYAN (CLINICAL PSYCHOLOGIST) |
| Mailing Address: | 40 Lambert St Ste 222 Staunton |
| State: | VA US |
| Postal Code: | 244012446 |
| Phone Number: | 5408863956 |
| Fax Number: | 5408863975 |
| NPI Enumeration Date: | 03/17/2016 |
| NPI Last Update Date: | 03/17/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 0810001474 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | VA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |