Provider Demographics
NPI:1881477651
Name:RILEY, TAI DOMINIQUE (RSW, BSW)
Entity type:Individual
Prefix:
First Name:TAI
Middle Name:DOMINIQUE
Last Name:RILEY
Suffix:
Gender:F
Credentials:RSW, BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6035 TUSCANY LN
Mailing Address - Street 2:
Mailing Address - City:SORRENTO
Mailing Address - State:LA
Mailing Address - Zip Code:70778-3420
Mailing Address - Country:US
Mailing Address - Phone:225-202-8280
Mailing Address - Fax:
Practice Address - Street 1:6035 TUSCANY LANE
Practice Address - Street 2:SORRENTO
Practice Address - City:SORRENTO
Practice Address - State:LA
Practice Address - Zip Code:70778
Practice Address - Country:US
Practice Address - Phone:225-202-8280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-16
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
LA17649104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No171M00000XOther Service ProvidersCase Manager/Care Coordinator