Provider Demographics
NPI:1881974863
Name:RILEY, KATHLEEN M (ND)
Entity type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:M
Last Name:RILEY
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2434 BERLIN TPKE
Mailing Address - Street 2:SUITE 18
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111-4121
Mailing Address - Country:US
Mailing Address - Phone:860-665-1254
Mailing Address - Fax:860-665-7135
Practice Address - Street 1:2434 BERLIN TPKE
Practice Address - Street 2:SUITE 18
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-4121
Practice Address - Country:US
Practice Address - Phone:860-665-1254
Practice Address - Fax:860-665-7135
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-23
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000079175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath