Healthcare Provider Details

I. General information

NPI: 1659137545
Provider Name (Legal Business Name): RILEY MARIE JARRELL CSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RILEY MARIE JARRELL RILEY JARRELL, CSW

II. Dates (important events)

Enumeration Date: 02/27/2024
Last Update Date: 02/27/2024
Certification Date: 02/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 GIBSON BAY DR FL 2
RICHMOND KY
40475-3544
US

IV. Provider business mailing address

3800 NICHOLASVILLE RD APT 12317
LEXINGTON KY
40503-6349
US

V. Phone/Fax

Practice location:
  • Phone: 855-591-0092
  • Fax:
Mailing address:
  • Phone: 812-746-0294
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number258749
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: