1952535981 NPI number — MS. PATRICIA MARIE RILEY L.C.S.W.

Table of content: MS. PATRICIA MARIE RILEY L.C.S.W. (NPI 1952535981)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952535981 NPI number — MS. PATRICIA MARIE RILEY L.C.S.W.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RILEY
Provider First Name:
PATRICIA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
L.C.S.W.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1952535981
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/05/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 22
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BURSON
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95225-0022
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
209-256-2832
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
23 W SAINT CHARLES ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN ANDREAS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95249
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
209-256-2832
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/05/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  LCS 25356 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: LCS 25356 . This is a "BOARD OF BEHAVIORAL SCIENCES" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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