Provider Demographics
NPI:1750432639
Name:RILEY, DEBORAH ELIZABETH (LICSW)
Entity type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:ELIZABETH
Last Name:RILEY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:ELIZABETH
Other - Last Name:RILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5 EVERGREEN LN
Mailing Address - Street 2:
Mailing Address - City:FISKDALE
Mailing Address - State:MA
Mailing Address - Zip Code:01518-1174
Mailing Address - Country:US
Mailing Address - Phone:508-347-9661
Mailing Address - Fax:
Practice Address - Street 1:5 EVERGREEN LN
Practice Address - Street 2:
Practice Address - City:FISKDALE
Practice Address - State:MA
Practice Address - Zip Code:01518-1174
Practice Address - Country:US
Practice Address - Phone:508-347-9661
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA211196104100000X
MA1186661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker