MEDICARE: MS. CAROL RILEY LCSW LMP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	LW00005246	WA
2	225700000X	Massage Therapist	MA00000248	WA

General Provider Information

NPI Number	:	1003979642
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CAROL RILEY LCSW LMP

Provider Business Mailing Address
First Line	:	4649 SUNNYSIDE AVE NO
Second Line	:	SUITE 340
City	:	SEATTLE
State	:	WA
Zip	:	98103-6955
Country	:	US
Telephone Number	:	206-545-4266
Fax Number	:

Provider Business Practice Location Address
First Line	:	4649 SUNNYSIDE AVE NO
Second Line	:	SUITE 340
City	:	SEATTLE
State	:	WA
Zip	:	98103-6955
Country	:	US
Telephone Number	:	206-545-4266
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/18/2006
Last Update Date	:	09/11/2025

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