Provider Demographics
NPI:1790591444
Name:RILEY, CAROLINE
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:
Last Name:RILEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 BOUGAINVILLEA AVE
Mailing Address - Street 2:
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33040-6226
Mailing Address - Country:US
Mailing Address - Phone:847-227-7119
Mailing Address - Fax:
Practice Address - Street 1:513 FLEMING ST STE 14
Practice Address - Street 2:
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-6887
Practice Address - Country:US
Practice Address - Phone:305-453-6334
Practice Address - Fax:305-453-6374
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-07
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-24-389424106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician