Provider Demographics
NPI:1811008527
Name:RYAN, KATHLEEN R (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:R
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 1:13 BOHL AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12209-1002
Mailing Address - Country:US
Mailing Address - Phone:518-852-7892
Mailing Address - Fax:518-438-6867
Practice Address - Street 1:1 PINNACLE PL
Practice Address - Street 2:SUITE 202
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-3496
Practice Address - Country:US
Practice Address - Phone:518-852-7892
Practice Address - Fax:518-438-6867
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR041427-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY338825OtherMVP
NY7344539OtherVALUEOPTIONS
NYIA0812Medicare ID - Type Unspecified