Healthcare Provider Details

I. General information

NPI: 1780368159
Provider Name (Legal Business Name): ANNE SONYA RYAN MS, MA, LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2023
Last Update Date: 06/14/2023
Certification Date: 06/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 CALLE DEL PRESIDENTE
BERNALILLO NM
87004-6091
US

IV. Provider business mailing address

8 CALLE LAGARTIJAS
PLACITAS NM
87043-9504
US

V. Phone/Fax

Practice location:
  • Phone: 505-252-4882
  • Fax:
Mailing address:
  • Phone: 505-307-9828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberM-07848
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: