=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851765853
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | PATRICIA LYNN RYAN M.A.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/15/2015
-----------------------------------------------------
Last Update Date | 08/05/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 304 MAIN AVE. SUITE 208
-----------------------------------------------------
City | NORWALK
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06851-6144
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-688-7143
-----------------------------------------------------
Fax | 877-637-7491
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 304 MAIN AVE. SUITE 208
-----------------------------------------------------
City | NORWALK
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06851-6144
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-688-7143
-----------------------------------------------------
Fax | 877-637-7491
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | PRC14718
-----------------------------------------------------
License Number State | DC
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 4952
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------