Provider Demographics
NPI:1295812618
Name:RILEY, LOIS L (LCSW)
Entity type:Individual
Prefix:MS
First Name:LOIS
Middle Name:L
Last Name:RILEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:427 LAKESIDE PASS
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-8273
Mailing Address - Country:US
Mailing Address - Phone:830-608-4494
Mailing Address - Fax:
Practice Address - Street 1:427 LAKESIDE PASS
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-8273
Practice Address - Country:US
Practice Address - Phone:830-608-4494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2008-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX336101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX071337203Medicaid
TX071337203Medicaid
TX8D0791Medicare ID - Type Unspecified