Provider Demographics
NPI:1609645852
Name:RONAN, CHRISTOPHER FRANCES (CASAC)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:FRANCES
Last Name:RONAN
Suffix:
Gender:M
Credentials:CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 E MAIN ST UNIT 7
Mailing Address - Street 2:
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-2443
Mailing Address - Country:US
Mailing Address - Phone:631-508-9555
Mailing Address - Fax:
Practice Address - Street 1:240 W MAIN ST
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-2841
Practice Address - Country:US
Practice Address - Phone:631-369-7800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-12-29
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY31805101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)