Healthcare Provider Details

I. General information

NPI: 1932811593
Provider Name (Legal Business Name): CHRISTIANA MARIE RYAN MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTIANA MARIE ROMANO MA, LPC

II. Dates (important events)

Enumeration Date: 12/14/2022
Last Update Date: 12/14/2022
Certification Date: 12/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1142 W MADISON ST STE 302
CHICAGO IL
60607-2191
US

IV. Provider business mailing address

1367 W HUBBARD ST UNIT 1
CHICAGO IL
60642-6475
US

V. Phone/Fax

Practice location:
  • Phone: 312-324-4502
  • Fax:
Mailing address:
  • Phone: 630-707-0614
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number178018699
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: