Provider Demographics
NPI:1982923728
Name:RYAN, SEAN D (LCMHC, LADC)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:D
Last Name:RYAN
Suffix:
Gender:M
Credentials:LCMHC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:856 UPPER QUARRY RD
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:VT
Mailing Address - Zip Code:05855-8878
Mailing Address - Country:US
Mailing Address - Phone:802-673-6088
Mailing Address - Fax:
Practice Address - Street 1:856 UPPER QUARRY RD
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:VT
Practice Address - Zip Code:05855-8878
Practice Address - Country:US
Practice Address - Phone:802-673-6088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-19
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT000473101YA0400X
VT0680054951101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)