Provider Demographics
NPI:1790205243
Name:RYAN, MEGAN (MHC-LP)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:RYAN
Suffix:
Gender:F
Credentials:MHC-LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 BISHOP LN
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11741-5009
Mailing Address - Country:US
Mailing Address - Phone:631-569-9380
Mailing Address - Fax:
Practice Address - Street 1:1235 MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:MASTIC
Practice Address - State:NY
Practice Address - Zip Code:11950
Practice Address - Country:US
Practice Address - Phone:631-924-3741
Practice Address - Fax:631-874-3786
Is Sole Proprietor?:No
Enumeration Date:2017-06-26
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPO5350101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health