Healthcare Provider Details

I. General information

NPI: 1700990819
Provider Name (Legal Business Name): KATHLEEN ANNE RYAN LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 RICHMOND AVE
BATAVIA NY
14020-1227
US

IV. Provider business mailing address

163 WENDOVER RD
ROCHESTER NY
14610-2346
US

V. Phone/Fax

Practice location:
  • Phone: 585-297-1054
  • Fax:
Mailing address:
  • Phone: 585-297-1054
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number070891
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: