Provider Demographics
NPI:1346889102
Name:RILEY, LINDA (EDS, MA)
Entity Type:Individual
Prefix:MRS
First Name:LINDA
Middle Name:
Last Name:RILEY
Suffix:
Gender:F
Credentials:EDS, MA
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 453662
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34745-3662
Mailing Address - Country:US
Mailing Address - Phone:727-277-1098
Mailing Address - Fax:
Practice Address - Street 1:1216 PATRICK ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-5534
Practice Address - Country:US
Practice Address - Phone:321-236-1540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-26
Last Update Date:2019-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health