Healthcare Provider Details

I. General information

NPI: 1922362011
Provider Name (Legal Business Name): PAMELA L RILEY LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2012
Last Update Date: 07/08/2025
Certification Date: 07/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 BUTLER DR
PROVIDENCE RI
02906-4862
US

IV. Provider business mailing address

455 TOLL GATE ROAD PRC AND CREDENTIALING
WARWICK RI
02886-2759
US

V. Phone/Fax

Practice location:
  • Phone: 401-227-3669
  • Fax: 401-736-1010
Mailing address:
  • Phone: 401-243-0641
  • Fax: 401-273-2919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW02162
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: