Provider Demographics
NPI:1700990819
Name:RYAN, KATHLEEN ANNE (LMSW)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:ANNE
Last Name:RYAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:163 WENDOVER RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14610-2346
Mailing Address - Country:US
Mailing Address - Phone:585-297-1054
Mailing Address - Fax:
Practice Address - Street 1:222 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:BATAVIA
Practice Address - State:NY
Practice Address - Zip Code:14020-1227
Practice Address - Country:US
Practice Address - Phone:585-297-1054
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY070891104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker