Provider Demographics
NPI:1609357771
Name:RILEY, LAURA B
Entity Type:Individual
Prefix:MRS
First Name:LAURA
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 1:48 VALLEY VIEW DR
Mailing Address - Street 2:
Mailing Address - City:OSWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13126-6049
Mailing Address - Country:US
Mailing Address - Phone:315-402-6171
Mailing Address - Fax:
Practice Address - Street 1:335 W 1ST ST STE 2
Practice Address - Street 2:
Practice Address - City:OSWEGO
Practice Address - State:NY
Practice Address - Zip Code:13126-3672
Practice Address - Country:US
Practice Address - Phone:315-343-3344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-27
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health