Provider Demographics
NPI:1710182175
Name:ANITA A. RYAN, LLC
Entity Type:Organization
Organization Name:ANITA A. RYAN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:304-263-4741
Mailing Address - Street 1:304 W BURKE ST
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-3324
Mailing Address - Country:US
Mailing Address - Phone:304-263-4741
Mailing Address - Fax:
Practice Address - Street 1:304 W BURKE ST
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-3324
Practice Address - Country:US
Practice Address - Phone:304-263-4741
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-18
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVDP009384571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty