Individual
JAMAAL EMMANUEL RYAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LSW
Contact information
Practice address
913 RENATE DR UNIT 3, HILLSBOROUGH, NJ 08844-4952
(908) 705-3653
Mailing address
913 RENATE DR UNIT 3, HILLSBOROUGH, NJ 08844-4952
(908) 705-3653
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
104100000X
Social Worker
Primary
44SL05958600
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0023701
AGENCY MEDICAID PROVIDER #
NJ
Enumeration date
09/10/2012
Last updated
02/17/2021
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