Provider Demographics
NPI:1598861965
Name:RYDER, MARTHA J (LCSW)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:J
Last Name:RYDER
Suffix:
Gender:F
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:PO BOX 7043
Mailing Address - Street 2:
Mailing Address - City:SCARBOROUGH
Mailing Address - State:ME
Mailing Address - Zip Code:04070-7043
Mailing Address - Country:US
Mailing Address - Phone:888-773-8380
Mailing Address - Fax:888-773-8380
Practice Address - Street 1:275 MAIN ST
Practice Address - Street 2:#204
Practice Address - City:BIDDEFORD
Practice Address - State:ME
Practice Address - Zip Code:04005-2432
Practice Address - Country:US
Practice Address - Phone:888-773-8380
Practice Address - Fax:888-773-8380
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2017-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC42101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME278590099Medicaid
MEE400368897Medicare PIN
MEMM9550Medicare PIN