Provider Demographics
NPI:1033502638
Name:RYAN-JOHNSON, PATRICIA DENISE (LCSW-R)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:DENISE
Last Name:RYAN-JOHNSON
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 SAINT ANDREWS PATH
Mailing Address - Street 2:
Mailing Address - City:WADING RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:11792-2324
Mailing Address - Country:US
Mailing Address - Phone:917-561-0474
Mailing Address - Fax:
Practice Address - Street 1:146 E 49TH ST
Practice Address - Street 2:APT. 9 C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-1212
Practice Address - Country:US
Practice Address - Phone:917-561-0474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-06
Last Update Date:2015-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY73 0781671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical