Provider Demographics
NPI:1609191899
Name:RYERSON, ANNE B
Entity Type:Individual
Prefix:MS
First Name:ANNE
Middle Name:B
Last Name:RYERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RIVERHEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11901-2672
Mailing Address - Country:US
Mailing Address - Phone:631-369-1277
Mailing Address - Fax:631-205-3445
Practice Address - Street 1:550 E MAIN ST
Practice Address - Street 2:
Practice Address - City:RIVERHEAD
Practice Address - State:NY
Practice Address - Zip Code:11901-2672
Practice Address - Country:US
Practice Address - Phone:631-369-1277
Practice Address - Fax:631-205-3445
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-31
Last Update Date:2010-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY230548-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health