Provider Demographics
NPI:1508496365
Name:KOREN, RILEY
Entity Type:Individual
Prefix:
First Name:RILEY
Middle Name:
Last Name:KOREN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 BIRDWOOD CT
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTESVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22903-5308
Mailing Address - Country:US
Mailing Address - Phone:773-308-5304
Mailing Address - Fax:
Practice Address - Street 1:618 FOREST ST STE 2
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22903-5267
Practice Address - Country:US
Practice Address - Phone:773-308-5304
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-21
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health