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General NPI Number Information
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NPI Number | 1275853202
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Entity Type | Individual
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Provider Name | ALYSON RYAN LCSW
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Gender | Female
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Dates
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Enumeration Date | 06/01/2010
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Last Update Date | 06/02/2010
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Provider Practice Location Address
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Address Line | 170 LITTLE EAST NECK RD
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City | WEST BABYLON
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State | NY
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Zip | 11704-7742
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Country | US
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Telephone | 631-379-5306
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Fax |
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Provider Business Mailing Address
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Address Line | 257 JOHNSON AVE
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City | SAYVILLE
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State | NY
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Zip | 11782-1118
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Country | US
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Telephone | 631-379-5306
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 075773
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License Number State | NY
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