Provider Demographics
NPI:1659707131
Name:RYAN, ALEXANDRA (LACMH)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:RYAN
Suffix:
Gender:F
Credentials:LACMH
Other - Prefix:
Other - First Name:SASHA
Other - Middle Name:
Other - Last Name:RYAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LACMH
Mailing Address - Street 1:39225 PARADISE LN
Mailing Address - Street 2:
Mailing Address - City:OCEAN VIEW
Mailing Address - State:DE
Mailing Address - Zip Code:19970-3490
Mailing Address - Country:US
Mailing Address - Phone:302-584-7516
Mailing Address - Fax:302-467-1747
Practice Address - Street 1:39225 PARADISE LN
Practice Address - Street 2:
Practice Address - City:OCEAN VIEW
Practice Address - State:DE
Practice Address - Zip Code:19970-3490
Practice Address - Country:US
Practice Address - Phone:302-584-7516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-17
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
DEAC-0010308101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)