Provider Demographics
NPI:1588030365
Name:RILEY, EKATERINA ELIZABETH (BCBA)
Entity Type:Individual
Prefix:
First Name:EKATERINA
Middle Name:ELIZABETH
Last Name:RILEY
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 S RAILROAD AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:MS
Mailing Address - Zip Code:38652-3805
Mailing Address - Country:US
Mailing Address - Phone:662-598-2050
Mailing Address - Fax:662-593-6109
Practice Address - Street 1:300 S RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:MS
Practice Address - Zip Code:38652-3805
Practice Address - Country:US
Practice Address - Phone:662-598-2050
Practice Address - Fax:662-593-6109
Is Sole Proprietor?:No
Enumeration Date:2015-08-17
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSRBT-15-01444103K00000X
MS1-21-50421103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSRBT-15-01444OtherBEHAVIOR ANALYST CERTIFICATION BOARD