MEDICARE: DR. ELIZABETH RYAN MSW, PHD

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	1041C0700X	Clinical Social Worker	R023428-1	NY

General Provider Information

NPI Number	:	1447578422
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELIZABETH RYAN MSW, PHD

Provider Business Mailing Address
First Line	:	75 MAIDEN LN
Second Line	:	SUITE 333
City	:	NEW YORK
State	:	NY
Zip	:	10038-4810
Country	:	US
Telephone Number	:	914-310-7527
Fax Number	:

Provider Business Practice Location Address
First Line	:	1273 NORTH AVE
Second Line	:	9-1B
City	:	NEW ROCHELLE
State	:	NY
Zip	:	10804-2702
Country	:	US
Telephone Number	:	914-310-7527
Fax Number	:

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

Provider Enumeration Date	:	05/14/2010
Last Update Date	:	05/14/2010

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