Provider Demographics
NPI:1356418032
Name:RYAN, GINGER (LICSW)
Entity type:Individual
Prefix:
First Name:GINGER
Middle Name:
Last Name:RYAN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 PEARL ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02139-4041
Mailing Address - Country:US
Mailing Address - Phone:617-547-7537
Mailing Address - Fax:617-547-7537
Practice Address - Street 1:46 PEARL ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02139-4041
Practice Address - Country:US
Practice Address - Phone:617-547-7537
Practice Address - Fax:617-547-7537
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2012-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10217271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MARY P23721Medicare ID - Type Unspecified