Healthcare Provider Details

I. General information

NPI: 1679129399
Provider Name (Legal Business Name): ALEXANDRA LEA RYAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2019
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

239 BOSTON ST
TOPSFIELD MA
01983-2215
US

IV. Provider business mailing address

5 WINTHROP AVE
MARBLEHEAD MA
01945-1629
US

V. Phone/Fax

Practice location:
  • Phone: 585-732-1005
  • Fax:
Mailing address:
  • Phone: 585-732-1005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number124454
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number000225094
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: