=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376987990
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SETH T.C. RIKER LCSW
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/25/2013
-----------------------------------------------------
Last Update Date | 04/25/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13 N 6TH ST #300
-----------------------------------------------------
City | NEW BEDFORD
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02740-6125
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 774-929-7420
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 23 OYSTER COVE RD
-----------------------------------------------------
City | SOUTH YARMOUTH
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02664-2320
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 508-254-5687
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 215197
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------