Provider Demographics
NPI:1053854513
Name:RILEY-BASS, KASEANIA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KASEANIA
Middle Name:
Last Name:RILEY-BASS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 S ZARZAMORA ST STE 301
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78207-5249
Mailing Address - Country:US
Mailing Address - Phone:210-556-5016
Mailing Address - Fax:
Practice Address - Street 1:700 S ZARZAMORA ST STE 301
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78207-5249
Practice Address - Country:US
Practice Address - Phone:210-556-5016
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-30
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1952103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical