Provider Demographics
NPI:1255800637
Name:RYAN, JAMIE LEE (LCSW, LCADC)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:LEE
Last Name:RYAN
Suffix:
Gender:F
Credentials:LCSW, LCADC
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:LEE
Other - Last Name:AGENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:47 PEACH TREE AVE
Mailing Address - Street 2:
Mailing Address - City:EAST HANOVER
Mailing Address - State:NJ
Mailing Address - Zip Code:07936-1559
Mailing Address - Country:US
Mailing Address - Phone:973-362-8924
Mailing Address - Fax:
Practice Address - Street 1:47 PEACH TREE AVE
Practice Address - Street 2:
Practice Address - City:EAST HANOVER
Practice Address - State:NJ
Practice Address - Zip Code:07936-1559
Practice Address - Country:US
Practice Address - Phone:973-362-8924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-15
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC000343000101YA0400X
TNLSW00000089691041C0700X
NJ44SC060190001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)