Provider Demographics
NPI:1427575810
Name:RYAN, SHERMAN KELLEY JR (LCSW)
Entity Type:Individual
Prefix:MR
First Name:SHERMAN
Middle Name:KELLEY
Last Name:RYAN
Suffix:JR
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 SE MAYNARD ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27511
Mailing Address - Country:US
Mailing Address - Phone:919-272-6220
Mailing Address - Fax:
Practice Address - Street 1:1250 SE MAYNARD RD STE 204
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27511-6947
Practice Address - Country:US
Practice Address - Phone:919-948-7718
Practice Address - Fax:919-300-7718
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-25
Last Update Date:2017-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC004348104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker