Healthcare Provider Details

I. General information

NPI: 1376987990
Provider Name (Legal Business Name): SETH T.C. RIKER LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2013
Last Update Date: 04/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 N 6TH ST #300
NEW BEDFORD MA
02740-6125
US

IV. Provider business mailing address

23 OYSTER COVE RD
SOUTH YARMOUTH MA
02664-2320
US

V. Phone/Fax

Practice location:
  • Phone: 774-929-7420
  • Fax:
Mailing address:
  • Phone: 508-254-5687
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number215197
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: