Healthcare Provider Details

I. General information

NPI: 1891736211
Provider Name (Legal Business Name): TRESSA RENEE RYAN MSW, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 12/29/2023
Certification Date: 12/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 CENTRAL AVE STE 103
DOVER NH
03820-3495
US

IV. Provider business mailing address

165 DEER HILL RD
BRENTWOOD NH
03833-6600
US

V. Phone/Fax

Practice location:
  • Phone: 603-964-1700
  • Fax: 603-749-7502
Mailing address:
  • Phone: 603-964-1700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number126906
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberNH819
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: