Provider Demographics
NPI:1770049579
Name:O'RYAN, JOHN (LMHC)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:O'RYAN
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2007 KIM DR
Mailing Address - Street 2:
Mailing Address - City:ENDICOTT
Mailing Address - State:NY
Mailing Address - Zip Code:13760-1416
Mailing Address - Country:US
Mailing Address - Phone:516-428-5650
Mailing Address - Fax:
Practice Address - Street 1:1355 US-11
Practice Address - Street 2:
Practice Address - City:KIRKWOOD
Practice Address - State:NY
Practice Address - Zip Code:13795
Practice Address - Country:US
Practice Address - Phone:607-203-1593
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-16
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009324101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional