Provider Demographics
NPI:1093352940
Name:RIEGER, RORY RICHARD (CADC-II)
Entity Type:Individual
Prefix:
First Name:RORY
Middle Name:RICHARD
Last Name:RIEGER
Suffix:
Gender:M
Credentials:CADC-II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3517
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94912-3517
Mailing Address - Country:US
Mailing Address - Phone:415-457-8182
Mailing Address - Fax:415-689-9050
Practice Address - Street 1:1399 N HAMILTON PKWY
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94949-8206
Practice Address - Country:US
Practice Address - Phone:415-457-8182
Practice Address - Fax:415-689-9050
Is Sole Proprietor?:No
Enumeration Date:2019-12-10
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARA9640919101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)