Provider Demographics
NPI:1700091287
Name:RYAN, KELLY MCCABE (MA, CAGS,, LMH)
Entity Type:Individual
Prefix:MS
First Name:KELLY
Middle Name:MCCABE
Last Name:RYAN
Suffix:
Gender:F
Credentials:MA, CAGS,, LMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 BURGATE STREET
Mailing Address - Street 2:
Mailing Address - City:CHEPACHET
Mailing Address - State:RI
Mailing Address - Zip Code:02814-2303
Mailing Address - Country:US
Mailing Address - Phone:401-952-8188
Mailing Address - Fax:
Practice Address - Street 1:27 BURGATE ST
Practice Address - Street 2:
Practice Address - City:CHEPACHET
Practice Address - State:RI
Practice Address - Zip Code:02814-2303
Practice Address - Country:US
Practice Address - Phone:401-952-8188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2008-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health