Provider Demographics
NPI:1922100684
Name:RIELLY, RONALD L (EDD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:L
Last Name:RIELLY
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68443 MAPLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIRSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43950-9117
Mailing Address - Country:US
Mailing Address - Phone:740-695-4994
Mailing Address - Fax:
Practice Address - Street 1:2121 EOFF ST
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-3805
Practice Address - Country:US
Practice Address - Phone:304-234-3570
Practice Address - Fax:304-234-3511
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1287101YP2500X
WV769103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001719065OtherBCBS
WV9204055000Medicaid
WVRICP25692Medicare PIN
WVRICP25696Medicare PIN
WV9204055000Medicaid