MEDICARE: LINDA RYAN LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker
2	1041C0700X	Clinical Social Worker	093175-01	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	WVE061	OTHER	NY	MEDICARE #

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1285628552	OTHER	NY	AGENCY

General Provider Information

NPI Number	:	1104222975
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA RYAN LCSW

Provider Business Mailing Address
First Line	:	105 CORPORATE PARK DR APT 3050
Second Line	:
City	:	WEST HARRISON
State	:	NY
Zip	:	10604-3331
Country	:	US
Telephone Number	:	914-873-1087
Fax Number	:

Provider Business Practice Location Address
First Line	:	105 CORPORATE PARK DR
Second Line	:	#3050
City	:	WEST HARRISON
State	:	NY
Zip	:	10604-3331
Country	:	US
Telephone Number	:	914-873-1087
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/06/2014
Last Update Date	:	12/29/2023

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Directions to “ LINDA RYAN LCSW” Practice Location

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