=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013462118
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LEIGH RILEY LMHC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/18/2016
-----------------------------------------------------
Last Update Date | 08/18/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 450 PEARL ST SUITE 3&3B
-----------------------------------------------------
City | STOUGHTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02072-1610
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-281-2485
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 50 W BROADWAY APT 227
-----------------------------------------------------
City | BOSTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02127-1140
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 617-281-2485
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 9684
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------