Provider Demographics
NPI:1609144302
Name:RIDLEY, STANLEY E (PHD)
Entity type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:E
Last Name:RIDLEY
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 1:4360 VARNUM PL NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20017-2101
Mailing Address - Country:US
Mailing Address - Phone:202-529-8508
Mailing Address - Fax:202-269-6353
Practice Address - Street 1:4360 VARNUM PL NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-2101
Practice Address - Country:US
Practice Address - Phone:202-529-8508
Practice Address - Fax:202-269-6353
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-08
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC1198103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist