Provider Demographics
NPI:1568523298
Name:RYAN, PATRICIA (LICSW)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:
Last Name:RYAN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 OAK ST
Mailing Address - Street 2:
Mailing Address - City:GREAT BARRINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01230-1706
Mailing Address - Country:US
Mailing Address - Phone:413-528-1613
Mailing Address - Fax:413-443-7957
Practice Address - Street 1:276 SOUTH ST
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-6835
Practice Address - Country:US
Practice Address - Phone:413-443-5768
Practice Address - Fax:413-443-7957
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MASW MASS 10080811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
062741000OtherMAGELLAN
MA16108OtherHEALTH NEW ENGLAND
MA1892088Medicaid
062741000OtherMAGELLAN