Healthcare Provider Details

I. General information

NPI: 1548348063
Provider Name (Legal Business Name): RICHARD FRANCIS RYAN LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 03/04/2019
Certification Date:
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: 505-930-5415
  • Fax:
Mailing address:
  • Phone: 505-930-5415
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS23135
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberC-05176
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: