Provider Demographics
NPI:1922167840
Name:RILEY, JONATHAN M (PHD)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:M
Last Name:RILEY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CROSSROADS PSYCHOLOGICAL ASSOCIATES
Mailing Address - Street 2:170 AVE. AT THE COMMON, SUITE 8A
Mailing Address - City:SHREWSBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:07702-4595
Mailing Address - Country:US
Mailing Address - Phone:732-542-8043
Mailing Address - Fax:
Practice Address - Street 1:CROSSROADS PSYCHOLOGICAL ASSOCIATES
Practice Address - Street 2:170 AVE. AT THE COMMON, SUITE 8A
Practice Address - City:SHREWSBURY
Practice Address - State:NJ
Practice Address - Zip Code:07702-4595
Practice Address - Country:US
Practice Address - Phone:732-542-8043
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ3403103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
O60088Medicare UPIN
RI892846QUCMedicare ID - Type Unspecified