Active NPI
John Thomas Ryan, LCSW-R
- Clinical Social Worker
- Canandaigua, NY
National Provider Identifier
1255470670
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- R045190-1
- Practice address
- 23 Sly St
Canandaigua, NY 14424-1809 - Phone
- (585) 919-0014
- NPI assigned
- Feb 5, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | R045190-1 | NY | Primary |
Addresses
Primary practice location
23 Sly St
Canandaigua, NY 14424-1809
Mailing address
7270 Montgomery LN
Victor, NY 14564-9780
Phone (585) 924-5189
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20180214000125 | NY | Practitioner - Clinical Social Worker | 3274893102 | Practice locations: Canandaigua, NY |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R045190-1 | NY | MD | Clinical Social Worker |
| 045190 | NY | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1170633600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1255470670",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7270 MONTGOMERY LN",
"city": "VICTOR",
"state": "NY",
"postal_code": "145649780",
"telephone_number": "585-924-5189"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "23 SLY ST",
"city": "CANANDAIGUA",
"state": "NY",
"postal_code": "144241809",
"telephone_number": "585-919-0014"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RYAN",
"first_name": "JOHN",
"middle_name": "THOMAS",
"name_prefix": "Mr.",
"credential": "LCSW-R",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-02-05",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NY",
"license": "R045190-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Canandaigua, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.