Provider Demographics
NPI:1518333012
Name:RILEY, MATTHEW
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:
Last Name:RILEY
Suffix:
Gender:M
Credentials:
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 49
Mailing Address - Street 2:
Mailing Address - City:AGAWAM
Mailing Address - State:MA
Mailing Address - Zip Code:01001-0049
Mailing Address - Country:US
Mailing Address - Phone:978-886-7564
Mailing Address - Fax:
Practice Address - Street 1:444 BROADWAY ROUTE 1
Practice Address - Street 2:MARTIGNETTI CENTER UNIT B #1051
Practice Address - City:SAUGUS
Practice Address - State:MA
Practice Address - Zip Code:01906
Practice Address - Country:US
Practice Address - Phone:978-886-7564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-08-19
Last Update Date:2023-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health