Provider Demographics
NPI:1750589289
Name:MESSATZZIA, RYAN KEVIN (LCSW-C)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:KEVIN
Last Name:MESSATZZIA
Suffix:
Gender:M
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10417 COUNTRY GROVE CIR
Mailing Address - Street 2:
Mailing Address - City:DELMAR
Mailing Address - State:DE
Mailing Address - Zip Code:19940-3485
Mailing Address - Country:US
Mailing Address - Phone:302-423-9960
Mailing Address - Fax:
Practice Address - Street 1:2336 GODDARD PKWY
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-1126
Practice Address - Country:US
Practice Address - Phone:410-334-6961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-05
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD145711041C0700X
DEQ1-00008861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD259147-000OtherMAGELLAN BEHAVIORAL HEALTH
MD522156095OtherOPTUM
MD7840093OtherAETNA
MDR968OtherBCBS - FEDERAL
MD522156095OtherAMERICAN PSYCH GROUP
MD609550001Medicaid
MDLM49EAOtherBCBS OF MARYLAND
MD346646OtherMHN
MD7840093OtherAETNA