Provider Demographics
NPI:1982765012
Name:RILEY, ANITA L (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:ANITA
Middle Name:L
Last Name:RILEY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MISS
Other - First Name:ANITA
Other - Middle Name:L
Other - Last Name:MCLAUGHLIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:585 LINCOLN STREET
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-1906
Mailing Address - Country:US
Mailing Address - Phone:508-854-3320
Mailing Address - Fax:508-753-5051
Practice Address - Street 1:214 HOWARD STREET
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-8311
Practice Address - Country:US
Practice Address - Phone:508-875-5801
Practice Address - Fax:508-753-5051
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2009-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1130711041C0700X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA042611055OtherTAX ID
MA1306421Medicaid
MAM18633OtherBCBC
M18684OtherBCBS
MANP01332OtherBMC
MA1303287OtherMBHP
MA1004745OtherNHP
MA1303287Medicaid
MA703136OtherTUFTS
MAY10400Medicare PIN