Healthcare Provider Details

I. General information

NPI: 1891999751
Provider Name (Legal Business Name): KELLY LYNNE RYAN-SCHMIDT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2007
Last Update Date: 01/08/2025
Certification Date: 01/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

408-410 E. 6TH AVE.
TARENTUM PA
15084
US

IV. Provider business mailing address

410 E 6TH AVE
TARENTUM PA
15084-1904
US

V. Phone/Fax

Practice location:
  • Phone: 412-212-3111
  • Fax:
Mailing address:
  • Phone: 412-212-3111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCWO15675
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberCW015675
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1740274
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerPA BLUE SHEILD NUMBER

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: