Provider Demographics
NPI:1396292967
Name:DIMEGLIO, RYAN (LCSW, LCADC)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:DIMEGLIO
Suffix:
Gender:M
Credentials:LCSW, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 JUMPING BROOK RD.
Mailing Address - Street 2:BLDG 5, STE 201, ATTN: BEHAVIORAL HEALTH CREDENTIALING
Mailing Address - City:NEPTUNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07753
Mailing Address - Country:US
Mailing Address - Phone:732-643-4372
Mailing Address - Fax:732-643-4376
Practice Address - Street 1:661 SHREWSBURY AVE
Practice Address - Street 2:
Practice Address - City:SHREWSBURY
Practice Address - State:NJ
Practice Address - Zip Code:07702-4183
Practice Address - Country:US
Practice Address - Phone:732-643-4363
Practice Address - Fax:732-643-4376
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC056977001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical