Provider Demographics
NPI:1639318959
Name:RYAN, LISA M (LPC, MA)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:RYAN
Suffix:
Gender:F
Credentials:LPC, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 POST ROAD WEST
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880
Mailing Address - Country:US
Mailing Address - Phone:203-226-8800
Mailing Address - Fax:203-226-8811
Practice Address - Street 1:181 POST ROAD WEST
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880
Practice Address - Country:US
Practice Address - Phone:203-226-8800
Practice Address - Fax:203-226-8811
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-10
Last Update Date:2009-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001433101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor