Provider Demographics
NPI:1679945810
Name:RILEY, MARYBETH (RN, CADC)
Entity Type:Individual
Prefix:MRS
First Name:MARYBETH
Middle Name:
Last Name:RILEY
Suffix:
Gender:F
Credentials:RN, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:449 FOREST AVE
Mailing Address - Street 2:SUITE #14
Mailing Address - City:PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04101-2029
Mailing Address - Country:US
Mailing Address - Phone:207-400-0157
Mailing Address - Fax:
Practice Address - Street 1:449 FOREST AVE
Practice Address - Street 2:SUITE #14
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-2029
Practice Address - Country:US
Practice Address - Phone:207-400-0157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-27
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECAC4853101YA0400X
MERN63144163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)