Provider Demographics
NPI:1417627969
Name:RILEY, BREEANNA (LMSW)
Entity Type:Individual
Prefix:
First Name:BREEANNA
Middle Name:
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 1:209 21ST ST APT 7
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11232-1351
Mailing Address - Country:US
Mailing Address - Phone:404-406-4646
Mailing Address - Fax:
Practice Address - Street 1:17 BATTERY PL STE 1232
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10004-1110
Practice Address - Country:US
Practice Address - Phone:646-640-6980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-16
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY114008104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker