Provider Demographics
NPI:1881192011
Name:RILEY, JESSICA D (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:D
Last Name:RILEY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 CABANISS CRES APT 2
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32508-1082
Mailing Address - Country:US
Mailing Address - Phone:225-933-5558
Mailing Address - Fax:
Practice Address - Street 1:31 CABANISS CRES APT 2
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32508-1082
Practice Address - Country:US
Practice Address - Phone:225-933-5558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-23
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL10989103TC0700X
VA081005935103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical