Provider Demographics
NPI:1689365512
Name:RILEY, JAMES EDWARD (LAC)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:EDWARD
Last Name:RILEY
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 ROUTE 73 N STE 104
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-3422
Mailing Address - Country:US
Mailing Address - Phone:718-551-5662
Mailing Address - Fax:
Practice Address - Street 1:103 A ST
Practice Address - Street 2:
Practice Address - City:PORT READING
Practice Address - State:NJ
Practice Address - Zip Code:07064-1601
Practice Address - Country:US
Practice Address - Phone:718-551-5662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-19
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00594700101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor