Provider Demographics
NPI:1992042154
Name:RYAN, MELISSA (LICSW)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:
Last Name:RYAN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:259 SAMUEL BARNET BLVD UNIT 2
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02745-1214
Mailing Address - Country:US
Mailing Address - Phone:508-995-3251
Mailing Address - Fax:
Practice Address - Street 1:259 SAMUEL BARNET BLVD UNIT 2
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02745-1214
Practice Address - Country:US
Practice Address - Phone:508-995-3251
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-08
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1151181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical