Provider Demographics
NPI:1942415237
Name:RYAN, ANNE C (LCSW)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:C
Last Name:RYAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1483 CHAIN BRIDGE ROAD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:MCLEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-5703
Mailing Address - Country:US
Mailing Address - Phone:703-200-8568
Mailing Address - Fax:703-356-8719
Practice Address - Street 1:1483 CHAIN BRIDGE ROAD
Practice Address - Street 2:SUITE 205
Practice Address - City:MCLEAN
Practice Address - State:VA
Practice Address - Zip Code:22101-5703
Practice Address - Country:US
Practice Address - Phone:703-200-8568
Practice Address - Fax:703-356-8719
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040026371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA119125OtherVALUE OPTIONS LOGIN