Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 109062-01 | NY |
NPI | 1003448556 |
---|---|
Provider Name | Rebecca Ryan |
First Address | Glens Falls, NY 12801-3731 |
Second Address | Hudson Falls, NY 12839-9632 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/02/2020 |
Last Update Date | 12/02/2020 |