Provider Demographics
NPI:1811121973
Name:RYAN, KATHERINE JOY (LCSW)
Entity type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:JOY
Last Name:RYAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2090 GREAT HIGHWAY
Mailing Address - Street 2:SUITE # 203
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94116-1055
Mailing Address - Country:US
Mailing Address - Phone:415-731-1500
Mailing Address - Fax:
Practice Address - Street 1:2090 GREAT HWY
Practice Address - Street 2:SUITE # 203
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94116-1064
Practice Address - Country:US
Practice Address - Phone:415-731-1500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-05
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS108721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical