Provider Demographics
NPI:1164315693
Name:RYAN, ASHLEY HARTE (LADC-II)
Entity type:Individual
Prefix:
First Name:ASHLEY
Middle Name:HARTE
Last Name:RYAN
Suffix:
Gender:F
Credentials:LADC-II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:566 MASSACHUSETTS AVE
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-1402
Mailing Address - Country:US
Mailing Address - Phone:617-262-5032
Mailing Address - Fax:
Practice Address - Street 1:566 MASSACHUSETTS AVE APT 3
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02118-1402
Practice Address - Country:US
Practice Address - Phone:617-262-5032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-02
Last Update Date:2025-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
MA18321101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty