Provider Demographics
NPI:1952873382
Name:RYAN, CATHERINE ANNE (LCSW)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:ANNE
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 1:27 RANDOLPH RD
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07731-8611
Mailing Address - Country:US
Mailing Address - Phone:718-298-3822
Mailing Address - Fax:888-371-0842
Practice Address - Street 1:5075 W SENECA TPKE
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13215-3216
Practice Address - Country:US
Practice Address - Phone:718-298-3822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-25
Last Update Date:2018-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY069778-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical