Basic Information
| Provider Information | |||||||||
| NPI: | 1750589289 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MESSATZZIA | ||||||||
| FirstName: | RYAN | ||||||||
| MiddleName: | KEVIN | ||||||||
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| Credential: | LCSW-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10417 COUNTRY GROVE CIR | ||||||||
| Address2: | |||||||||
| City: | DELMAR | ||||||||
| State: | DE | ||||||||
| PostalCode: | 199403485 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3024239960 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2336 GODDARD PKWY | ||||||||
| Address2: | |||||||||
| City: | SALISBURY | ||||||||
| State: | MD | ||||||||
| PostalCode: | 218011126 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4103346961 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2007 | ||||||||
| LastUpdateDate: | 07/25/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 14571 | MD | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | Q1-0000886 | DE | N | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 259147-000 | 01 | MD | MAGELLAN BEHAVIORAL HEALTH | OTHER | 522156095 | 01 | MD | OPTUM | OTHER | 7840093 | 01 | MD | AETNA | OTHER | R968 | 01 | MD | BCBS - FEDERAL | OTHER | 522156095 | 01 | MD | AMERICAN PSYCH GROUP | OTHER | 609550001 | 05 | MD | MEDICAID | LM49EA | 01 | MD | BCBS OF MARYLAND | OTHER | 346646 | 01 | MD | MHN | OTHER |