Provider Demographics
NPI:1568138030
Name:RILEY, JULIE B
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:B
Last Name:RILEY
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 1:1268 BOCA GRANDE AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32233-2205
Mailing Address - Country:US
Mailing Address - Phone:904-608-0782
Mailing Address - Fax:
Practice Address - Street 1:10840 NORTH US HIGHWAY
Practice Address - Street 2:SUITE 301
Practice Address - City:OXFORD
Practice Address - State:FL
Practice Address - Zip Code:34484
Practice Address - Country:US
Practice Address - Phone:352-445-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-17
Last Update Date:2021-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW18762101YM0800X
FL138071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty