Kenyatta Indira Ruan-Bryan, LCSW-C

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

22700 Issued in MD

Practice address

5606 Benton Heights Ave
Baltimore, MD 21206-3550

Phone

(443) 762-9719

NPI assigned

May 11, 2023

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

• Kenyatta Indira Tomika Ruan Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1683763200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1683763200000",
    "number": "1306536313",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5606 BENTON HEIGHTS AVE",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212063550",
            "telephone_number": "443-762-9719"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5606 BENTON HEIGHTS AVE",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212063550",
            "telephone_number": "443-762-9719"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RUAN-BRYAN",
        "first_name": "KENYATTA",
        "middle_name": "INDIRA",
        "credential": "LCSW-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2023-05-11",
        "last_updated": "2023-05-11",
        "certification_date": "2023-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MD",
            "license": "22700",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KENYATTA",
            "last_name": "RUAN",
            "middle_name": "INDIRA TOMIKA",
            "credential": "LCSW-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Jessica Hodge Rubens, M.D.
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• Clinical Social Worker in Baltimore, MD
• Providers in Baltimore, MD by specialty
• Clinical Social Worker in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2023; 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.