Provider Demographics
NPI:1215167127
Name:RYERSON, GERALYN (LPCMH)
Entity type:Individual
Prefix:
First Name:GERALYN
Middle Name:
Last Name:RYERSON
Suffix:
Gender:F
Credentials:LPCMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5177 W WOODMILL DR
Mailing Address - Street 2:SUITE 6
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-4067
Mailing Address - Country:US
Mailing Address - Phone:302-999-8426
Mailing Address - Fax:302-999-8761
Practice Address - Street 1:1601 MILLTOWN RD
Practice Address - Street 2:SUITE 8
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-4027
Practice Address - Country:US
Practice Address - Phone:302-547-3060
Practice Address - Fax:302-547-3060
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-27
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEPC-0000470101YM0800X
101Y00000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional