Jennifer Lynn Ryan, MS, LADC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

001059 Issued in CT

Practice address

30 Controls Drive
Suite 10
Shelton, CT 06484-5434

Phone

(475) 675-2981

Fax

(475) 675-2982

NPI assigned

Sep 3, 2008

Last updated

Sep 18, 2015By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Jennifer Lynn Park Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1220400000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1442534400000",
    "number": "1083862197",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "30 CONTROLS DRIVE",
            "address_2": "SUITE 10",
            "city": "SHELTON",
            "state": "CT",
            "postal_code": "064845434",
            "telephone_number": "475-675-2981",
            "fax_number": "475-675-2982"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 CONTROLS DRIVE",
            "address_2": "SUITE 10",
            "city": "SHELTON",
            "state": "CT",
            "postal_code": "064845434",
            "telephone_number": "475-675-2981",
            "fax_number": "475-675-2982"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RYAN",
        "first_name": "JENNIFER",
        "middle_name": "LYNN",
        "name_prefix": "Mrs.",
        "credential": "MS, LADC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-09-03",
        "last_updated": "2015-09-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CT",
            "license": "001059",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "PARK",
            "middle_name": "LYNN",
            "credential": "MS, LADC, CCDP-D",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Kerry D Rudich, PT
• Gabrielle Russitano, LMSW
• Nyasia Russo
• Arianna Sabatino, DPT
• Michael J Safian, D.D.S.
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• Avery Michael Sage, LCSW
• Rayna P Salemme, MA, BSN, RN

• Addiction (Substance Use Disorder) Counselor in Shelton, CT
• Providers in Shelton, CT by specialty
• Addiction (Substance Use Disorder) Counselor in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 18, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.