Provider Demographics
NPI:1497175061
Name:ENGELSTAD, RYAN (LCSW)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:
Last Name:ENGELSTAD
Suffix:
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 1:491 AMWELL RD
Mailing Address - Street 2:BUILDING 1 SUITE 103
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NJ
Mailing Address - Zip Code:08844-8212
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:491 AMWELL RD
Practice Address - Street 2:BUILDING 1 SUITE 103
Practice Address - City:HILLSBOROUGH
Practice Address - State:NJ
Practice Address - Zip Code:08844-8212
Practice Address - Country:US
Practice Address - Phone:732-275-2826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-23
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC055803001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical