Provider Demographics
NPI:1720312408
Name:RILEY, MADELINE MEYER (MFT)
Entity Type:Individual
Prefix:MS
First Name:MADELINE
Middle Name:MEYER
Last Name:RILEY
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2012 TIFFIN RD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94602-1906
Mailing Address - Country:US
Mailing Address - Phone:510-331-8173
Mailing Address - Fax:
Practice Address - Street 1:2012 TIFFIN RD
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94602-1906
Practice Address - Country:US
Practice Address - Phone:510-331-8173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-28
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC29229106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist