Provider Demographics
NPI:1427233436
Name:RILEY, KEVIN YOUNG (LCSW)
Entity Type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:YOUNG
Last Name:RILEY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 3RD AVE SW
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:OR
Mailing Address - Zip Code:97321-2261
Mailing Address - Country:US
Mailing Address - Phone:541-231-7538
Mailing Address - Fax:541-812-0116
Practice Address - Street 1:420 3RD AVE SW
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:OR
Practice Address - Zip Code:97321-2261
Practice Address - Country:US
Practice Address - Phone:541-231-7538
Practice Address - Fax:541-812-0116
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-09
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL32951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical