Provider Demographics
NPI:1780368159
Name:RYAN, ANNE SONYA (MS, MA, LMSW)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:SONYA
Last Name:RYAN
Suffix:
Gender:F
Credentials:MS, MA, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 CALLE LAGARTIJAS
Mailing Address - Street 2:
Mailing Address - City:PLACITAS
Mailing Address - State:NM
Mailing Address - Zip Code:87043-9504
Mailing Address - Country:US
Mailing Address - Phone:505-307-9828
Mailing Address - Fax:
Practice Address - Street 1:121 CALLE DEL PRESIDENTE
Practice Address - Street 2:
Practice Address - City:BERNALILLO
Practice Address - State:NM
Practice Address - Zip Code:87004-6091
Practice Address - Country:US
Practice Address - Phone:505-252-4882
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-07848104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker