MEDICARE: RYAN CORWIN BYRD MSW, LICSW

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	1041C0700X	Clinical Social Worker	LC303633	DC

General Provider Information

NPI Number	:	1538358254
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN CORWIN BYRD MSW, LICSW

Provider Business Mailing Address
First Line	:	4360 WELSH LN
Second Line	:	APARTMENT 1
City	:	WOODBRIDGE
State	:	VA
Zip	:	22193-5649
Country	:	US
Telephone Number	:	571-435-4601
Fax Number	:

Provider Business Practice Location Address
First Line	:	6856 EASTERN AVE NW
Second Line	:	SUITE 286
City	:	WASHINGTON
State	:	DC
Zip	:	20012-2165
Country	:	US
Telephone Number	:	202-723-6600
Fax Number	:	202-723-2549

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

Provider Enumeration Date	:	10/18/2007
Last Update Date	:	10/18/2007

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