MEDICARE: RILEY LEA PLASS

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	104100000X	Social Worker

General Provider Information

NPI Number	:	1467344341
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RILEY LEA PLASS

Provider Business Mailing Address
First Line	:	10570 MAIN ST APT 221
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22030-7104
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9400 INNOVATION DR STE 104
Second Line	:
City	:	MANASSAS
State	:	VA
Zip	:	20110-2226
Country	:	US
Telephone Number	:	571-626-4231
Fax Number	:

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

Provider Enumeration Date	:	07/16/2025
Last Update Date	:	07/16/2025

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Directions to “ RILEY LEA PLASS ” Practice Location

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