Provider Demographics
NPI:1225798010
Name:ALLEN, RYAN DALE (LMSW)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:DALE
Last Name:ALLEN
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:482 BLACK RIVER PKWY
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-2416
Mailing Address - Country:US
Mailing Address - Phone:315-317-8650
Mailing Address - Fax:315-785-8628
Practice Address - Street 1:482 BLACK RIVER PKWY
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-2416
Practice Address - Country:US
Practice Address - Phone:315-317-8650
Practice Address - Fax:315-785-8628
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-21
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY114972104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker