1982765012 NPI number — MRS. ANITA L RILEY LICSW

Table of content: MRS. ANITA L RILEY LICSW (NPI 1982765012)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982765012 NPI number — MRS. ANITA L RILEY LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RILEY
Provider First Name:
ANITA
Provider Middle Name:
L
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LICSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCLAUGHLIN
Provider Other First Name:
ANITA
Provider Other Middle Name:
L
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
LICSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1982765012
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/15/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
585 LINCOLN STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WORCESTER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01605-1906
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-854-3320
Provider Business Mailing Address Fax Number:
508-753-5051

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
214 HOWARD STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRAMINGHAM
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01702-8311
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-875-5801
Provider Business Practice Location Address Fax Number:
508-753-5051
Provider Enumeration Date:
12/13/2006

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:  113071 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 042611055 . This is a "TAX ID" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1306421 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: M18633 . This is a "BCBC" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: M18684 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: NP01332 . This is a "BMC" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1303287 . This is a "MBHP" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1004745 . This is a "NHP" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1303287 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 703136 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com