Provider Demographics
NPI:1962819847
Name:RILEY, CYNTHIA NORMAN (LMT LPC)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:NORMAN
Last Name:RILEY
Suffix:
Gender:F
Credentials:LMT LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 PINE ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08094-1139
Mailing Address - Country:US
Mailing Address - Phone:443-941-4206
Mailing Address - Fax:610-537-5043
Practice Address - Street 1:2801 ISLAND AVE STE 14
Practice Address - Street 2:FLOOR 1
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19153-2326
Practice Address - Country:US
Practice Address - Phone:484-844-9890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-12
Last Update Date:2019-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMSG008037174400000X
PAPC007940101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No174400000XOther Service ProvidersSpecialist