Provider Demographics
NPI:1770855389
Name:SHIRILLA, RYAN (LICSW)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:SHIRILLA
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:447 DEERPATH LN
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:NH
Mailing Address - Zip Code:03275-3214
Mailing Address - Country:US
Mailing Address - Phone:773-885-2303
Mailing Address - Fax:
Practice Address - Street 1:447 DEERPATH LN
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:NH
Practice Address - Zip Code:03275-3214
Practice Address - Country:US
Practice Address - Phone:773-885-2303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-30
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH15861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical