Healthcare Provider Details

I. General information

NPI: 1538243191
Provider Name (Legal Business Name): GINA M RYAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 FULTON AVE
HEMPSTEAD NY
11550-3718
US

IV. Provider business mailing address

175 FULTON AVE
HEMPSTEAD NY
11550-3718
US

V. Phone/Fax

Practice location:
  • Phone: 516-485-5710
  • Fax: 516-485-4225
Mailing address:
  • Phone: 516-485-5710
  • Fax: 516-485-4225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number04535
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: