Provider Demographics
NPI:1194120212
Name:RYAN, MARCY E (LCSW)
Entity type:Individual
Prefix:
First Name:MARCY
Middle Name:E
Last Name:RYAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 BLUEBIRD RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH GLENS FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12803-5704
Mailing Address - Country:US
Mailing Address - Phone:518-857-0600
Mailing Address - Fax:518-587-2248
Practice Address - Street 1:6 BLUEBIRD RD
Practice Address - Street 2:
Practice Address - City:SOUTH GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12803-5704
Practice Address - Country:US
Practice Address - Phone:518-857-0600
Practice Address - Fax:518-587-2248
Is Sole Proprietor?:No
Enumeration Date:2014-10-31
Last Update Date:2015-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY081255-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical