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NPI Code Detail

MEDICARE: JOANNE M RYAN LADC1

MEDICARE: JOANNE M RYAN LADC1
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
1101YA0400XAddiction (Substance Use Disorder) Counselor338MA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1338OTHERMALICENSE

General Provider Information

NPI Number : 1467514877
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOANNE M RYAN LADC1
Provider Business Mailing Address
First Line : 92 BRECKWOOD BLVD
Second Line :
City : SPRINGFIELD
State : MA
Zip : 01109-1303
Country : US
Telephone Number : 413-785-7555
Fax Number :
Provider Business Practice Location Address
First Line : 215 SHELBURNE RD
Second Line :
City : GREENFIELD
State : MA
Zip : 01301-9622
Country : US
Telephone Number : 413-774-1000
Fax Number : 413-774-1197
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/14/2006
Last Update Date : 07/08/2007

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Directions to “ JOANNE M RYAN LADC1” Practice Location

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