Provider Demographics
NPI:1053092007
Name:CRUIKSHANK, RYAN (LPCA)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:CRUIKSHANK
Suffix:
Gender:M
Credentials:LPCA
Other - Prefix:
Other - First Name:RYAN
Other - Middle Name:
Other - Last Name:CRUIKSHANK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPCA
Mailing Address - Street 1:21 ANN ST APT B32
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06854-2288
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:21 ANN ST APT B32
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06854-2288
Practice Address - Country:US
Practice Address - Phone:203-912-7639
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-31
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional