Healthcare Provider Details

I. General information

NPI: 1710182175
Provider Name (Legal Business Name): ANITA A. RYAN, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2007
Last Update Date: 07/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 W BURKE ST
MARTINSBURG WV
25401-3324
US

IV. Provider business mailing address

304 W BURKE ST
MARTINSBURG WV
25401-3324
US

V. Phone/Fax

Practice location:
  • Phone: 304-263-4741
  • Fax:
Mailing address:
  • Phone: 304-263-4741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberDP00938457
License Number StateWV

VIII. Authorized Official

Name: ANITA ANN RYAN
Title or Position: OWNER
Credential: MSW
Phone: 304-263-4741