Provider Demographics
NPI:1831846088
Name:RILEY, EUGENE JOSEPH I
Entity type:Individual
Prefix:
First Name:EUGENE
Middle Name:JOSEPH
Last Name:RILEY
Suffix:I
Gender:M
Credentials:
Other - Prefix:
Other - First Name:EUGENE
Other - Middle Name:JOSEPH
Other - Last Name:RILEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:1003 ARK ST
Mailing Address - Street 2:
Mailing Address - City:OGDENSBURG
Mailing Address - State:NY
Mailing Address - Zip Code:13699-1740
Mailing Address - Country:US
Mailing Address - Phone:716-579-2256
Mailing Address - Fax:
Practice Address - Street 1:1003 PARK ST
Practice Address - Street 2:
Practice Address - City:OGDENSBURG
Practice Address - State:NY
Practice Address - Zip Code:13669-3911
Practice Address - Country:US
Practice Address - Phone:518-481-1251
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-08
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY112651-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker