Jack Ryan, LADC, LPC

Primary specialty

Professional CounselorTaxonomy code 101YP2500X

License

003589 Issued in CT

Practice address

2475 Albany Ave Ste 203B
West Hartford, CT 06117-2523

Phone

(860) 519-6492

Fax

(860) 519-6492

NPI assigned

Nov 13, 2008

Last updated

Feb 8, 2019By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

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

Green means eligible to order or refer.

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.

• Creative Coaching and Addiction Counseling LLC

  • Addiction (Substance Use Disorder) Counselor
  • West Hartford, CT
  • NPI 1548712730
  NPD (past) Authorized official
• Cornerstone Counseling Center

  • Professional Counselor
  • Waterbury, CT
  • NPI 1316486889
  NPD

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

{
    "created_epoch": "1226534400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1549584000000",
    "number": "1922252246",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "53 MANOR LN",
            "city": "SOUTH WINDSOR",
            "state": "CT",
            "postal_code": "060743214",
            "telephone_number": "860-519-6492"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2475 ALBANY AVE STE 203B",
            "city": "WEST HARTFORD",
            "state": "CT",
            "postal_code": "061172523",
            "telephone_number": "860-519-6492",
            "fax_number": "860-519-6492"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RYAN",
        "first_name": "JACK",
        "credential": "LADC, LPC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-11-13",
        "last_updated": "2019-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "CT",
            "license": "0008885",
            "primary": false
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YP2500X",
            "taxonomy_group": "",
            "desc": "Counselor, Professional",
            "state": "CT",
            "license": "003589",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mark L Russell, APRN
• Gary Edward Russolillo, M.D.
• Michelle Rae Rusted
• Ruth L. Jacobson, Ms, LMFT, LLC
• Stanley J Rutstein, DPM
• Jessica-Lee Sabatino, FNP
• Sara Sabellico
• Julie B Saffir, PSY.D, LMFT
• Sage Psychotherapy LLC
• Michael Sagherian, BCBA

• Professional Counselor in West Hartford, CT
• Providers in West Hartford, CT by specialty
• Professional Counselor in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2019; 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.

Verify at the official NPI Registry.