Provider Demographics
NPI:1134426083
Name:RILEY, GRACE MARIE (PSYD)
Entity type:Individual
Prefix:DR
First Name:GRACE
Middle Name:MARIE
Last Name:RILEY
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 W CHURCH ST STE 1A
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-7800
Mailing Address - Country:US
Mailing Address - Phone:443-465-5920
Mailing Address - Fax:
Practice Address - Street 1:120 W CHURCH ST STE 1A
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701-7800
Practice Address - Country:US
Practice Address - Phone:443-465-5920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-11
Last Update Date:2011-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04830103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist