Provider Demographics
NPI:1346453271
Name:RIORDAN, ANN MARIE (ACSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ANN MARIE
Middle Name:
Last Name:RIORDAN
Suffix:
Gender:F
Credentials:ACSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4076 MEANDER PL
Mailing Address - Street 2:UNIT 102
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-5282
Mailing Address - Country:US
Mailing Address - Phone:321-794-8144
Mailing Address - Fax:321-690-6920
Practice Address - Street 1:4076 MEANDER PL
Practice Address - Street 2:UNIT 102
Practice Address - City:ROCKLEDGE
Practice Address - State:FL
Practice Address - Zip Code:32955-5282
Practice Address - Country:US
Practice Address - Phone:321-794-8144
Practice Address - Fax:321-690-6920
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2009-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP0236351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP023635OtherL.C.S.W.