Provider Demographics
NPI:1649401415
Name:MOSIER, RYAN PAUL (LISW)
Entity Type:Individual
Prefix:MR
First Name:RYAN
Middle Name:PAUL
Last Name:MOSIER
Suffix:
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3094 KENSINGTON RD
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:CLEVELAND HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44118-3572
Mailing Address - Country:US
Mailing Address - Phone:317-441-9932
Mailing Address - Fax:
Practice Address - Street 1:11801 BUCKEYE ROAD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44120-2620
Practice Address - Country:US
Practice Address - Phone:216-381-2255
Practice Address - Fax:216-378-3906
Is Sole Proprietor?:No
Enumeration Date:2009-07-28
Last Update Date:2010-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.09001281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0268768Medicaid