=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376011502
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PATRICIA RYAN-JOHNSON, LCSW PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/06/2018
-----------------------------------------------------
Last Update Date | 11/06/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 224 MORRIS AVE
-----------------------------------------------------
City | MALVERNE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11565-1215
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-341-7161
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 224 MORRIS AVE
-----------------------------------------------------
City | MALVERNE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11565-1215
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 516-341-7161
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MS. PATRICIA DENISE RYAN-JOHNSON
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 516-341-7161
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------