Provider Demographics
NPI:1952535981
Name:RILEY, PATRICIA MARIE (LCSW)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:MARIE
Last Name:RILEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 22
Mailing Address - Street 2:
Mailing Address - City:BURSON
Mailing Address - State:CA
Mailing Address - Zip Code:95225-0022
Mailing Address - Country:US
Mailing Address - Phone:209-256-2832
Mailing Address - Fax:
Practice Address - Street 1:23 W SAINT CHARLES ST
Practice Address - Street 2:
Practice Address - City:SAN ANDREAS
Practice Address - State:CA
Practice Address - Zip Code:95249
Practice Address - Country:US
Practice Address - Phone:209-256-2832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-05
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 253561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALCS 25356OtherBOARD OF BEHAVIORAL SCIENCES