Healthcare Provider Details

I. General information

NPI: 1225960164
Provider Name (Legal Business Name): LASHEENA RILEY-DUVAL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

158 ACADEMY LN
UPPER DARBY PA
19082-1302
US

IV. Provider business mailing address

158 ACADEMY LN
UPPER DARBY PA
19082-1302
US

V. Phone/Fax

Practice location:
  • Phone: 267-972-8939
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW026317
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: