Provider Demographics
NPI:1174688568
Name:RYAN, SONIA (LICSW, CAC)
Entity Type:Individual
Prefix:MS
First Name:SONIA
Middle Name:
Last Name:RYAN
Suffix:
Gender:F
Credentials:LICSW, CAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 WALNUT ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702-7500
Mailing Address - Country:US
Mailing Address - Phone:508-370-0992
Mailing Address - Fax:508-370-0283
Practice Address - Street 1:223 WALNUT ST
Practice Address - Street 2:SUITE 1
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-7500
Practice Address - Country:US
Practice Address - Phone:508-370-0992
Practice Address - Fax:508-370-0283
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10153801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA007179OtherHARVARD PILGRIM
MAP05459OtherBLUE CROSS BLUE SHIELD
MAP05459OtherBLUE CROSS BLUE SHIELD