Provider Demographics
NPI:1255700274
Name:RYAN, AMY SUE (LCSW)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:SUE
Last Name:RYAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:AMY
Other - Middle Name:S
Other - Last Name:MOLLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:13 POLO CLUB DR
Mailing Address - Street 2:
Mailing Address - City:TINTON FALLS
Mailing Address - State:NJ
Mailing Address - Zip Code:07724-3823
Mailing Address - Country:US
Mailing Address - Phone:732-284-7016
Mailing Address - Fax:
Practice Address - Street 1:13 MAIN ST # 1
Practice Address - Street 2:
Practice Address - City:BRADLEY BEACH
Practice Address - State:NJ
Practice Address - Zip Code:07720-1027
Practice Address - Country:US
Practice Address - Phone:732-795-0918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-21
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC052189001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical