Healthcare Provider Details

I. General information

NPI: 1467316307
Provider Name (Legal Business Name): RILEY MCKENZIE O'SHEA LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

595 BLOSSOM RD STE 120
ROCHESTER NY
14610-1825
US

IV. Provider business mailing address

169 PENBROOKE DR
PENFIELD NY
14526-2016
US

V. Phone/Fax

Practice location:
  • Phone: 585-652-8087
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number128113
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: