Provider Demographics
NPI:1982630950
Name:RILEY, JANICE MARIE (MSW, LMSW, CAADC)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:MARIE
Last Name:RILEY
Suffix:
Gender:F
Credentials:MSW, LMSW, CAADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34924 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:MI
Mailing Address - Zip Code:48184-1206
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:34924 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:MI
Practice Address - Zip Code:48184-1206
Practice Address - Country:US
Practice Address - Phone:734-968-4497
Practice Address - Fax:313-450-4512
Is Sole Proprietor?:No
Enumeration Date:2006-06-23
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801063285104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker