Provider Demographics
NPI:1831350537
Name:RILEY, WILLIAM M
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:M
Last Name:RILEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 SENECA ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:GENEVA
Mailing Address - State:NY
Mailing Address - Zip Code:14456-3505
Mailing Address - Country:US
Mailing Address - Phone:315-789-1442
Mailing Address - Fax:
Practice Address - Street 1:17 SENECA ST
Practice Address - Street 2:SUITE 5
Practice Address - City:GENEVA
Practice Address - State:NY
Practice Address - Zip Code:14456-3505
Practice Address - Country:US
Practice Address - Phone:315-789-1442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-24
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR041371-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical