Provider Demographics
NPI:1164605754
Name:RYAN, EMILY KATHERINE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:EMILY
Middle Name:KATHERINE
Last Name:RYAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DEPARTMENT OF MENTAL HEALTH
Mailing Address - Street 2:2155 IRON POINT RD
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630
Mailing Address - Country:US
Mailing Address - Phone:916-817-5629
Mailing Address - Fax:916-817-5610
Practice Address - Street 1:DEPARTMENT OF MENTAL HEALTH
Practice Address - Street 2:2155 IRON POINT RD
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630
Practice Address - Country:US
Practice Address - Phone:916-817-5629
Practice Address - Fax:916-817-5610
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-06
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 242301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical