Provider Demographics
NPI:1538358254
Name:BYRD, RYAN CORWIN (MSW, LICSW)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:CORWIN
Last Name:BYRD
Suffix:
Gender:M
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4360 WELSH LN
Mailing Address - Street 2:APARTMENT 1
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193-5649
Mailing Address - Country:US
Mailing Address - Phone:571-435-4601
Mailing Address - Fax:
Practice Address - Street 1:6856 EASTERN AVE NW
Practice Address - Street 2:SUITE 286
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20012-2165
Practice Address - Country:US
Practice Address - Phone:202-723-6600
Practice Address - Fax:202-723-2549
Is Sole Proprietor?:No
Enumeration Date:2007-10-18
Last Update Date:2007-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC3036331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical