Provider Demographics
NPI:1215389150
Name:RILEY, MICHAEL (LLMSW)
Entity Type:Individual
Prefix:MS
First Name:MICHAEL
Middle Name:
Last Name:RILEY
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:MS
Other - First Name:MICHAEL
Other - Middle Name:
Other - Last Name:RILEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LLMSW
Mailing Address - Street 1:6309 MACK AVE
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48207-2302
Mailing Address - Country:US
Mailing Address - Phone:313-267-2047
Mailing Address - Fax:313-379-1042
Practice Address - Street 1:6309 MACK AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48207-2302
Practice Address - Country:US
Practice Address - Phone:313-267-2047
Practice Address - Fax:313-274-4900
Is Sole Proprietor?:No
Enumeration Date:2016-07-03
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511144541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical