Provider Information for 1417622077
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Mrs. KELLEY RYAN LCSW
Sex: Female
NPI: 1417622077
Last Updated: 2021-08-14
Certification Date: 2021-08-14
Certification Date: 2021-08-14
Details
| Name | Value | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| NPI | 1417622077 | ||||||||
| Enumeration Date | 2021-08-14 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | YES | ||||||||
| Status | Active | ||||||||
| Mailing Address | 859 WEST BRIAR AVE TOMS RIVER, NJ 08753-4463 United States Phone: 732-684-1065 | Fax: | ||||||||
| Primary Practice Address | 859 WEST BRIAR AVE TOMS RIVER, NJ 08753-4463 United States Phone: 732-684-1065 | Fax: | ||||||||
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