Provider Demographics
NPI:1336821776
Name:RYAN, NADINE ANN (LPC)
Entity Type:Individual
Prefix:MRS
First Name:NADINE
Middle Name:ANN
Last Name:RYAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 BIRCH DR
Mailing Address - Street 2:
Mailing Address - City:HAMMONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08037-3307
Mailing Address - Country:US
Mailing Address - Phone:609-338-7452
Mailing Address - Fax:
Practice Address - Street 1:900 ROUTE 168 STE G3
Practice Address - Street 2:
Practice Address - City:TURNERSVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08012-3235
Practice Address - Country:US
Practice Address - Phone:856-302-5728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-04
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00192000101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional