Healthcare Provider Details

I. General information

NPI: 1366695637
Provider Name (Legal Business Name): LORI ANNE RILEY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2008
Last Update Date: 11/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 PLAZA EAST BLVD STE 224
EVANSVILLE IN
47715-2806
US

IV. Provider business mailing address

4416 WHITMOOR AVE
EVANSVILLE IN
47714-6549
US

V. Phone/Fax

Practice location:
  • Phone: 812-664-7718
  • Fax: 812-909-3001
Mailing address:
  • Phone: 812-664-7718
  • Fax: 812-909-3001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: