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General NPI Number Information
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NPI Number | 1811649833
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Entity Type | Organization
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Legal Business Name | DR. DONNA RILEY OFFICE OF LICENSED CLINICAL SOCIAL WORK, PLLC
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Dates
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Enumeration Date | 01/20/2022
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Last Update Date | 02/01/2022
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Provider Practice Location Address
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Address Line | 2233 NESCONSET HWY STE 100
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City | LAKE GROVE
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State | NY
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Zip | 11755-1000
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Country | US
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Telephone | 631-602-7856
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Fax | 631-602-7857
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Provider Business Mailing Address
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Address Line | 2233 NESCONSET HWY STE 100
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City | LAKE GROVE
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State | NY
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Zip | 11755-1000
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Country | US
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Telephone | 631-602-7856
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Fax | 631-602-7857
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Authorized Official
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Title or Position | CEO
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Name | DR. DONNA BARBARA RILEY
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Credential | PHD, LCSW-R
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Telephone | 516-983-1780
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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