Provider Demographics
NPI:1669288833
Name:O'CONNELL, RYAN G (LCSW)
Entity type:Individual
Prefix:MR
First Name:RYAN
Middle Name:G
Last Name:O'CONNELL
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Gender:M
Credentials:LCSW
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Mailing Address - Street 1:5 HEMPHILL PLACE
Mailing Address - Street 2:SUITE 121
Mailing Address - City:MALTA
Mailing Address - State:NY
Mailing Address - Zip Code:12020-4022
Mailing Address - Country:US
Mailing Address - Phone:518-289-5072
Mailing Address - Fax:518-289-5225
Practice Address - Street 1:2310 NOTT STREET EAST
Practice Address - Street 2:SUITE 3
Practice Address - City:NISKAYUNA
Practice Address - State:NY
Practice Address - Zip Code:12309-4345
Practice Address - Country:US
Practice Address - Phone:518-374-6263
Practice Address - Fax:518-289-5225
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-03
Last Update Date:2025-01-17
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Provider Licenses
StateLicense IDTaxonomies
NY0989501041C0700X
NY098950-011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical