Provider Demographics
NPI:1912038514
Name:RYAN, MARK C (LCSW)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:C
Last Name:RYAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 CLINTON AVE
Mailing Address - Street 2:APT 10 H
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11238-1176
Mailing Address - Country:US
Mailing Address - Phone:917-282-3782
Mailing Address - Fax:
Practice Address - Street 1:360 9TH AVE
Practice Address - Street 2:FLOOR 2
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215
Practice Address - Country:US
Practice Address - Phone:718-230-7151
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0735461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical