Provider Demographics
NPI:1689351900
Name:RILEY, TARA (LCSW-C, LICSW)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:RILEY
Suffix:
Gender:F
Credentials:LCSW-C, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8214 CAGLE RD
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20744-5507
Mailing Address - Country:US
Mailing Address - Phone:202-330-8934
Mailing Address - Fax:
Practice Address - Street 1:8214 CAGLE RD
Practice Address - Street 2:
Practice Address - City:FORT WASHINGTON
Practice Address - State:MD
Practice Address - Zip Code:20744-5507
Practice Address - Country:US
Practice Address - Phone:202-330-8934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-28
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC2000027291041C0700X
MD253021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty