Provider Demographics
NPI:1346010014
Name:RILEY, GENOVIA C (LMSW)
Entity Type:Individual
Prefix:
First Name:GENOVIA
Middle Name:C
Last Name:RILEY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4242 SUITLAND RD APT 203
Mailing Address - Street 2:
Mailing Address - City:SUITLAND
Mailing Address - State:MD
Mailing Address - Zip Code:20746-2053
Mailing Address - Country:US
Mailing Address - Phone:301-683-8590
Mailing Address - Fax:
Practice Address - Street 1:9106 PHILADELPHIA RD STE 208
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:MD
Practice Address - Zip Code:21237-4333
Practice Address - Country:US
Practice Address - Phone:443-530-6921
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-04
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD28674104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker