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General NPI Number Information
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NPI Number | 1750589289
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Entity Type | Individual
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Provider Name | RYAN KEVIN MESSATZZIA LCSW-C
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Gender | Male
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Dates
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Enumeration Date | 07/05/2007
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Last Update Date | 07/25/2014
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Provider Practice Location Address
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Address Line | 2336 GODDARD PKWY
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City | SALISBURY
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State | MD
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Zip | 21801-1126
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Country | US
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Telephone | 410-334-6961
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Fax |
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Provider Business Mailing Address
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Address Line | 10417 COUNTRY GROVE CIR
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City | DELMAR
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State | DE
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Zip | 19940-3485
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Country | US
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Telephone | 302-423-9960
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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 | 14571
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | Q1-0000886
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License Number State | DE
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