Healthcare Provider Details

I. General information

NPI: 1538637871
Provider Name (Legal Business Name): RICHARD F. RYAN, PHD, LCSW
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2018
Last Update Date: 10/21/2020
Certification Date: 10/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1502 S SAINT FRANCIS DR
SANTA FE NM
87505-4040
US

IV. Provider business mailing address

1502 S SAINT FRANCIS DR
SANTA FE NM
87505-4040
US

V. Phone/Fax

Practice location:
  • Phone: 505-310-8233
  • Fax: 505-930-5419
Mailing address:
  • Phone: 505-310-8233
  • Fax: 505-930-5419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MR. RICHARD FRANCIS RYAN
Title or Position: CEO
Credential: PHD LCSW
Phone: 505-983-5419