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General NPI Number Information
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NPI Number | 1568138030
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Entity Type | Individual
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Provider Name | JULIE B. RILEY
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Gender | Female
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Dates
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Enumeration Date | 08/17/2021
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Last Update Date | 10/14/2021
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Provider Practice Location Address
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Address Line | 10840 NORTH US HIGHWAY SUITE 301
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City | OXFORD
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State | FL
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Zip | 34484
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Country | US
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Telephone | 352-445-1200
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Fax |
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Provider Business Mailing Address
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Address Line | 1268 BOCA GRANDE AVE
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City | JACKSONVILLE
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State | FL
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Zip | 32233-2205
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Country | US
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Telephone | 904-608-0782
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | SW18762
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 13807
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License Number State | FL
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