Healthcare Provider Details

I. General information

NPI: 1770263683
Provider Name (Legal Business Name): KATHRYN M RYAN LCSW, LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2023
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 DOYLE AVE
PROVIDENCE RI
02906-1609
US

IV. Provider business mailing address

PO BOX 2388
PROVIDENCE RI
02906-0388
US

V. Phone/Fax

Practice location:
  • Phone: 401-213-9088
  • Fax:
Mailing address:
  • Phone: 401-213-9088
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC25760
License Number StateME
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW04814
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: