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General NPI Number Information
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NPI Number | 1982188397
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Entity Type | Individual
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Provider Name | STEPHANIE JANE RYDER LCSW
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Gender | Female
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Dates
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Enumeration Date | 09/21/2018
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Last Update Date | 04/09/2022
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Provider Practice Location Address
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Address Line | 119 W WOOD HILL DR STE 5
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City | NAGS HEAD
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State | NC
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Zip | 27959-8700
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Country | US
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Telephone | 252-489-6373
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1941
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City | KILL DEVIL HILLS
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State | NC
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Zip | 27948-1941
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Country | US
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Telephone | 252-489-0026
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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 | PO12429
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License Number State | NC
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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 | C014620
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License Number State | NC
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