Provider Demographics
NPI:1215253406
Name:RYAN, CHRISTOPHER (LICSW, CEAP)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:RYAN
Suffix:
Gender:M
Credentials:LICSW, CEAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1838 ELM ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03104-2966
Mailing Address - Country:US
Mailing Address - Phone:603-391-6547
Mailing Address - Fax:
Practice Address - Street 1:1838 ELM ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03104-2966
Practice Address - Country:US
Practice Address - Phone:603-391-6547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-13
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH10401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical