Provider Demographics
NPI:1932321692
Name:RILEY, ROBERT (CASAC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:RILEY
Suffix:
Gender:M
Credentials:CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 22036
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12201-2036
Mailing Address - Country:US
Mailing Address - Phone:631-852-1070
Mailing Address - Fax:631-852-1119
Practice Address - Street 1:550 MONTAUK HWY
Practice Address - Street 2:
Practice Address - City:SHIRLEY
Practice Address - State:NY
Practice Address - Zip Code:11967-2114
Practice Address - Country:US
Practice Address - Phone:631-852-1070
Practice Address - Fax:631-852-1119
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY3725101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)