Healthcare Provider Details

I. General information

NPI: 1346010014
Provider Name (Legal Business Name): GENOVIA C RILEY LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2024
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9106 PHILADELPHIA RD STE 208
ROSEDALE MD
21237-4333
US

IV. Provider business mailing address

4242 SUITLAND RD APT 203
SUITLAND MD
20746-2053
US

V. Phone/Fax

Practice location:
  • Phone: 443-530-6921
  • Fax:
Mailing address:
  • Phone: 301-683-8590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number28674
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: