Healthcare Provider Details
I. General information
NPI: 1184613200
Provider Name (Legal Business Name): ELIZABETH ANNE RILEY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y
II. Dates (important events)
Enumeration Date: 10/20/2005
Last Update Date: 12/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
3144 GRACEFIELD RD APT T19 RIDERWOOD VILLAGE, GARDEN VIEW
SILVER SPRING MD
20904-5895
US
IV. Provider business mailing address
3144 GRACEFIELD RD APT T19 RIDERWOOD VILLAGE, GARDEN VIEW
SILVER SPRING MD
20904-5895
US
V. Phone/Fax
- Phone: 301-273-2424
- Fax: 301-273-2426
- Phone: 301-273-2424
- Fax: 301-273-2426
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 1041C0700X |
| Taxonomy | Clinical Social Worker |
| License Number | 00761 |
| License Number State | MD |
| # 2 | |
| Primary Taxonomy | N |
| Taxonomy Code | 1041C0700X |
| Taxonomy | Clinical Social Worker |
| License Number | Q1-0000139 |
| License Number State | DE |
VII. Legacy identifiers
For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:
| # 1 | |
| Identifier | 348820-02 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | CAREFIRST BCBS MD |
| # 2 | |
| Identifier | 233332171 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | UNITED BEHAVIORAL HEALTH |
| # 3 | |
| Identifier | Q268EA |
| Identifier Type | OTHER |
| Identifier State | MD |
| Identifier Issuer | CAREFIRST BCBS |
| # 4 | |
| Identifier | 182331100 |
| Identifier Type | MEDICAID |
| Identifier State | MD |
| Identifier Issuer | |
| # 5 | |
| Identifier | 2148787 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | MAMSI/UHC |
| # 6 | |
| Identifier | H106-0001 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | CAREFIRST BCBS NCA |
| # 7 | |
| Identifier | 480695000 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | MAGELLAN |
| # 8 | |
| Identifier | 7183215 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | AETNA |
| # 9 | |
| Identifier | 001069 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | VALUEOPTIONS |
| # 10 | |
| Identifier | 252779000 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | MAGELLAN |
| # 11 | |
| Identifier | 348820-01 |
| Identifier Type | OTHER |
| Identifier State | DE |
| Identifier Issuer | CAREFIRST BCBS DE |
| # 12 | |
| Identifier | 1006810 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | CIGNA |
| # 13 | |
| Identifier | 217899 |
| Identifier Type | OTHER |
| Identifier State | |
| Identifier Issuer | KAISER PERMANENTE |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone:
