Provider Demographics
NPI:1073290904
Name:RYAN, CORINA
Entity Type:Individual
Prefix:
First Name:CORINA
Middle Name:
Last Name:RYAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:383 DORCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:LYME
Mailing Address - State:NH
Mailing Address - Zip Code:03768-3900
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:383 DORCHESTER RD
Practice Address - Street 2:
Practice Address - City:LYME
Practice Address - State:NH
Practice Address - Zip Code:03768-3900
Practice Address - Country:US
Practice Address - Phone:603-381-2551
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-03
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health