Healthcare Provider Details

I. General information

NPI: 1689989006
Provider Name (Legal Business Name): CORNELIA M RYAN MSW, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2010
Last Update Date: 08/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

54 FRONT ST
FALL RIVER MA
02721-4399
US

IV. Provider business mailing address

54 FRONT ST
FALL RIVER MA
02721-4399
US

V. Phone/Fax

Practice location:
  • Phone: 508-675-0686
  • Fax: 508-672-1576
Mailing address:
  • Phone: 508-675-0686
  • Fax: 508-672-1576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1020704
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: