Provider Demographics
NPI:1700394764
Name:RILEY, JOHN JAMES (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:JAMES
Last Name:RILEY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3524 WINSLOW DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90026-6216
Mailing Address - Country:US
Mailing Address - Phone:323-791-4107
Mailing Address - Fax:
Practice Address - Street 1:5757 WILSHIRE BLVD STE 635
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-3686
Practice Address - Country:US
Practice Address - Phone:323-791-4107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-11
Last Update Date:2018-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA775631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical