Provider Demographics
NPI:1679038145
Name:RYAN, IRENE H (LICSW)
Entity Type:Individual
Prefix:MS
First Name:IRENE
Middle Name:H
Last Name:RYAN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 MAIN RD
Mailing Address - Street 2:
Mailing Address - City:WESTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01027-9679
Mailing Address - Country:US
Mailing Address - Phone:413-531-1943
Mailing Address - Fax:
Practice Address - Street 1:91 MAIN RD
Practice Address - Street 2:
Practice Address - City:WESTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01027-9679
Practice Address - Country:US
Practice Address - Phone:413-531-1943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-08
Last Update Date:2019-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10187421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical