Provider Demographics
NPI:1639990302
Name:HEVRON, JOHN-RYAN (LMSW)
Entity type:Individual
Prefix:MR
First Name:JOHN-RYAN
Middle Name:
Last Name:HEVRON
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 PRESIDENT ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-1101
Mailing Address - Country:US
Mailing Address - Phone:917-674-6798
Mailing Address - Fax:
Practice Address - Street 1:116 CLINTON ST # 4
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-4204
Practice Address - Country:US
Practice Address - Phone:917-674-6798
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-24
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1251341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical