Provider Demographics
NPI:1760752422
Name:RISLEY JONES, REBECCA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:
Last Name:RISLEY JONES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2363 BURKERT RD
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13480-1401
Mailing Address - Country:US
Mailing Address - Phone:315-292-0477
Mailing Address - Fax:
Practice Address - Street 1:381 MADISON ST
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:NY
Practice Address - Zip Code:13480-1115
Practice Address - Country:US
Practice Address - Phone:315-841-3824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-11
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY07723511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical