Provider Demographics
NPI:1710071527
Name:RYAN, KATHERINE (LMHC, LCPC)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:RYAN
Suffix:
Gender:F
Credentials:LMHC, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 NEWBURY RD
Mailing Address - Street 2:
Mailing Address - City:IPSWICH
Mailing Address - State:MA
Mailing Address - Zip Code:01938-1016
Mailing Address - Country:US
Mailing Address - Phone:207-754-2968
Mailing Address - Fax:
Practice Address - Street 1:6 NEWBURY RD
Practice Address - Street 2:
Practice Address - City:IPSWICH
Practice Address - State:MA
Practice Address - Zip Code:01938-1016
Practice Address - Country:US
Practice Address - Phone:207-754-2968
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7007101YM0800X
MECC2544101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME104000000Medicaid
ME104000000Medicaid