Healthcare Provider Details

I. General information

NPI: 1780998013
Provider Name (Legal Business Name): REBECCA JANE RILEY PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2010
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8317 CASS ST
OMAHA NE
68114-3529
US

IV. Provider business mailing address

8317 CASS ST
OMAHA NE
68114-3529
US

V. Phone/Fax

Practice location:
  • Phone: 402-981-1017
  • Fax: 844-877-1903
Mailing address:
  • Phone: 402-981-1017
  • Fax: 844-877-1903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number06748
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number895
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: