Provider Demographics
NPI:1508523184
Name:RYAN, ANTOINETTE M (LPC)
Entity Type:Individual
Prefix:MRS
First Name:ANTOINETTE
Middle Name:M
Last Name:RYAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 SPRINGHAVEN CIR
Mailing Address - Street 2:
Mailing Address - City:ROYERSFORD
Mailing Address - State:PA
Mailing Address - Zip Code:19468-1178
Mailing Address - Country:US
Mailing Address - Phone:610-212-9715
Mailing Address - Fax:
Practice Address - Street 1:206 SPRINGHAVEN CIR
Practice Address - Street 2:
Practice Address - City:ROYERSFORD
Practice Address - State:PA
Practice Address - Zip Code:19468-1178
Practice Address - Country:US
Practice Address - Phone:610-212-9715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-18
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC013773101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional