Provider Demographics
NPI:1891999751
Name:RYAN-SCHMIDT, KELLY LYNNE (LCSW)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:LYNNE
Last Name:RYAN-SCHMIDT
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 1:410 E 6TH AVE
Mailing Address - Street 2:
Mailing Address - City:TARENTUM
Mailing Address - State:PA
Mailing Address - Zip Code:15084-1904
Mailing Address - Country:US
Mailing Address - Phone:412-212-3111
Mailing Address - Fax:
Practice Address - Street 1:408-410 E. 6TH AVE.
Practice Address - Street 2:
Practice Address - City:TARENTUM
Practice Address - State:PA
Practice Address - Zip Code:15084
Practice Address - Country:US
Practice Address - Phone:412-212-3111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACWO156751041C0700X
PACW015675104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1740274OtherPA BLUE SHEILD NUMBER