Kelly Marie Ryan, MLADC

Primary specialty

Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X

License

0989 Issued in NH

Practice address

445 Cypress St Ste 8
Manchester, NH 03103-3600

Phone

(603) 668-4079

Fax

(603) 663-8605

NPI assigned

Mar 20, 2012

Last updated

May 18, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NH

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Mental Health Counselor

Education

Other, 2011

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Elliot Professional ServicesGroup PAC ID 6103727920, 429 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Elliot Professional Services

  • Internal Medicine Physician
  • Manchester, NH
  • NPI 1285627935
  Medicare reassignment Care Compare group NPD
• Elliot Professional Services

  • Psychiatry Physician
  • Manchester, NH
  • NPI 1669431466
  NPD (past)

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

{
    "created_epoch": "1332201600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1589760000000",
    "number": "1538434790",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "445 CYPRESS ST STE 8",
            "city": "MANCHESTER",
            "state": "NH",
            "postal_code": "031033600",
            "telephone_number": "603-668-4079",
            "fax_number": "603-663-8605"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "445 CYPRESS ST STE 8",
            "city": "MANCHESTER",
            "state": "NH",
            "postal_code": "031033600",
            "telephone_number": "603-668-4079",
            "fax_number": "603-663-8605"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "132 Perry St",
            "address_purpose": "LOCATION",
            "city": "Trenton",
            "state": "NJ",
            "postal_code": "086183968",
            "country_code": "US",
            "telephone_number": "609-394-8988 x50",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RYAN",
        "first_name": "KELLY",
        "middle_name": "MARIE",
        "credential": "MLADC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-03-20",
        "last_updated": "2020-05-18",
        "certification_date": "2020-05-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NH",
            "license": "0989",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Victoria Dumoulin Russell, LICSW
• Grace C Rutherford, BS
• Anna Ryan, M.D.
• Christopher Ryan, LICSW, CEAP
• Jessica Lynn Ryan, M.D.
• Michael Ryan, BA
• Thomas A Ryan, CRSW
• Robert M Ryley, OTR/L
• Matthew William Ryzewski, D.O.
• John Sable

• Addiction (Substance Use Disorder) Counselor in Manchester, NH
• Providers in Manchester, NH by specialty
• Addiction (Substance Use Disorder) Counselor in New Hampshire

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 18, 2020; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.