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General NPI Number Information
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NPI Number | 1417913757
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Entity Type | Individual
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Provider Name | MICHELE DEVEREUX RYAN LCSW
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Gender | Female
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Dates
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Enumeration Date | 04/25/2006
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Last Update Date | 04/09/2018
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Provider Practice Location Address
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Address Line | 437 ORANGE ST
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City | NEW HAVEN
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State | CT
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Zip | 06511-6202
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Country | US
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Telephone | 203-215-0795
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Fax | 203-507-2754
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Provider Business Mailing Address
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Address Line | 667B HERITAGE VLG
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City | SOUTHBURY
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State | CT
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Zip | 06488-5501
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Country | US
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Telephone | 203-215-0795
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Fax | 203-507-2754
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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 | 003430
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License Number State | CT
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