Provider Demographics
NPI:1003396300
Name:RILEY, COSWAYLO E (MA)
Entity Type:Individual
Prefix:MS
First Name:COSWAYLO
Middle Name:E
Last Name:RILEY
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MS
Other - First Name:COSWAYLO
Other - Middle Name:E
Other - Last Name:HARRIS-RILEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:485 WILLIAMSTOWN RD PO BOX 112
Mailing Address - Street 2:
Mailing Address - City:SICKLERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08081
Mailing Address - Country:US
Mailing Address - Phone:856-728-4464
Mailing Address - Fax:856-629-7468
Practice Address - Street 1:485 WILLIAMSTOWN RD
Practice Address - Street 2:
Practice Address - City:SICKLERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08081
Practice Address - Country:US
Practice Address - Phone:856-728-4464
Practice Address - Fax:856-629-7468
Is Sole Proprietor?:No
Enumeration Date:2018-08-16
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ5168551103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool