Provider Demographics
NPI:1720373319
Name:RYAN, JAMIE LEE (MSW, LICSW)
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:LEE
Last Name:RYAN
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:MRS
Other - First Name:JAMIE
Other - Middle Name:LEE
Other - Last Name:CRIMMINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LICSW
Mailing Address - Street 1:79 CHURCH GREEN
Mailing Address - Street 2:
Mailing Address - City:TAUNTON
Mailing Address - State:MA
Mailing Address - Zip Code:02780
Mailing Address - Country:US
Mailing Address - Phone:508-824-2273
Mailing Address - Fax:508-824-2275
Practice Address - Street 1:79 CHURCH GREEN
Practice Address - Street 2:
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780
Practice Address - Country:US
Practice Address - Phone:508-824-2273
Practice Address - Fax:508-824-2275
Is Sole Proprietor?:No
Enumeration Date:2011-06-13
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
MA1177141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical