Provider Demographics
NPI:1053920595
Name:WOOD, RYAN ROBERT (LCSW, ICADC, CADC)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:ROBERT
Last Name:WOOD
Suffix:
Gender:M
Credentials:LCSW, ICADC, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:956 W 38TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16508-2531
Mailing Address - Country:US
Mailing Address - Phone:814-528-5000
Mailing Address - Fax:
Practice Address - Street 1:956 W 38TH ST
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16508-2531
Practice Address - Country:US
Practice Address - Phone:814-528-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-30
Last Update Date:2022-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLICDC.161934101YA0400X
PACW0222471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)