Provider Demographics
NPI:1033166376
Name:RILEY, DOUGLAS C (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:C
Last Name:RILEY
Suffix:
Gender:M
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 ROBERTA DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH DARTMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02748-2020
Mailing Address - Country:US
Mailing Address - Phone:508-992-9376
Mailing Address - Fax:508-992-9420
Practice Address - Street 1:8 ROBERTA DR
Practice Address - Street 2:
Practice Address - City:SOUTH DARTMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02748-2020
Practice Address - Country:US
Practice Address - Phone:508-992-9376
Practice Address - Fax:508-992-9420
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1005241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP01557OtherMA BLUE SHIELD
MA6212763OtherUNITED BEHAVIORAL HEALTH
MA000000022694OtherBMC HEALTHNET PLAN
MA008898OtherVALUE OPTIONS
MASO13145OtherCHAMPUS/TRICARE
MA176982OtherMAGELLAN BEHAVIORAL HEALT
MA2081751OtherCIGNA BEHVIORAL HEALTH
MA1892193OtherMBHP
MA6212763OtherUNITED BEHAVIORAL HEALTH