Provider Demographics
NPI:1467514877
Name:RYAN, JOANNE M (LADC1)
Entity Type:Individual
Prefix:
First Name:JOANNE
Middle Name:M
Last Name:RYAN
Suffix:
Gender:F
Credentials:LADC1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:92 BRECKWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01109-1303
Mailing Address - Country:US
Mailing Address - Phone:413-785-7555
Mailing Address - Fax:
Practice Address - Street 1:215 SHELBURNE RD
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301-9622
Practice Address - Country:US
Practice Address - Phone:413-774-1000
Practice Address - Fax:413-774-1197
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA338101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA338OtherLICENSE