Provider Demographics
NPI:1205178894
Name:RYAN, ANAMARIA
Entity Type:Individual
Prefix:MS
First Name:ANAMARIA
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 1:2503 DEL PRADO BLVD S STE 410
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33904-5709
Mailing Address - Country:US
Mailing Address - Phone:239-209-3301
Mailing Address - Fax:239-242-6389
Practice Address - Street 1:27499 RIVERVIEW CENTER BLVD STE 260
Practice Address - Street 2:
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134-4359
Practice Address - Country:US
Practice Address - Phone:239-494-0840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-21
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH12123101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional