Provider Demographics
NPI:1790341485
Name:RYAN, SHANNYN LEA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SHANNYN
Middle Name:LEA
Last Name:RYAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 HOMECROFT RD
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13206-3042
Mailing Address - Country:US
Mailing Address - Phone:315-706-8006
Mailing Address - Fax:
Practice Address - Street 1:138 N COURT ST
Practice Address - Street 2:
Practice Address - City:WAMPSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13163-7714
Practice Address - Country:US
Practice Address - Phone:315-366-2327
Practice Address - Fax:315-366-2599
Is Sole Proprietor?:No
Enumeration Date:2019-05-17
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY106060-1104100000X
NY0959831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker