Provider Demographics
NPI:1316433568
Name:RYAN, SARAH BEVERLY (LCSW)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:BEVERLY
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 1:30025 ALICIA PARKWAY
Mailing Address - Street 2:SUITE 649
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677
Mailing Address - Country:US
Mailing Address - Phone:949-791-9329
Mailing Address - Fax:
Practice Address - Street 1:30025 ALICIA PKWY STE 649
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-2090
Practice Address - Country:US
Practice Address - Phone:949-791-9329
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-10
Last Update Date:2025-01-09
Deactivation Date:2020-10-13
Deactivation Code:
Reactivation Date:2021-08-20
Provider Licenses
StateLicense IDTaxonomies
CA839601041C0700X
1041C0700X
CA1014271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical