Healthcare Provider Details

I. General information

NPI: 1255061081
Provider Name (Legal Business Name): JACQUELINE MARIE RIFE LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2022
Last Update Date: 09/26/2026
Certification Date: 09/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9029 WHITE WILLOW WAY
MORGANTOWN WV
26505-6224
US

IV. Provider business mailing address

714 VENTURE DR # 115
MORGANTOWN WV
26508-7306
US

V. Phone/Fax

Practice location:
  • Phone: 305-544-7085
  • Fax:
Mailing address:
  • Phone: 304-544-7085
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberDP00946329
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: