Provider Demographics
NPI:1548348063
Name:RYAN, RICHARD FRANCIS (LCSW)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:FRANCIS
Last Name:RYAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1502 S SAINT FRANCIS DR
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-4040
Mailing Address - Country:US
Mailing Address - Phone:505-930-5415
Mailing Address - Fax:
Practice Address - Street 1:1502 S SAINT FRANCIS DR
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4040
Practice Address - Country:US
Practice Address - Phone:505-930-5415
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS231351041C0700X
NMC-051761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical