Healthcare Provider Details

I. General information

NPI: 1467514877
Provider Name (Legal Business Name): JOANNE M RYAN LADC1
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 SHELBURNE RD
GREENFIELD MA
01301-9622
US

IV. Provider business mailing address

92 BRECKWOOD BLVD
SPRINGFIELD MA
01109-1303
US

V. Phone/Fax

Practice location:
  • Phone: 413-774-1000
  • Fax: 413-774-1197
Mailing address:
  • Phone: 413-785-7555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number338
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: