MEDICARE: RYA MCCANN LMSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	007257	IA
2	104100000X	Social Worker	6801099224	MI

General Provider Information

NPI Number	:	1528392719
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYA MCCANN LMSW

Provider Business Mailing Address
First Line	:	205 LOREE DR
Second Line	:
City	:	EAST LANSING
State	:	MI
Zip	:	48823-1924
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1750 E GRAND RIVER AVE STE 101
Second Line	:
City	:	EAST LANSING
State	:	MI
Zip	:	48823-4958
Country	:	US
Telephone Number	:	517-258-0414
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/22/2009
Last Update Date	:	04/11/2024

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