MEDICARE: MADELINE JOY RILEY MSW

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	:	1700368610
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADELINE JOY RILEY MSW

Provider Business Mailing Address
First Line	:	5462 WHITTLESEY BLVD APT 1431
Second Line	:
City	:	COLUMBUS
State	:	GA
Zip	:	31909-3057
Country	:	US
Telephone Number	:	845-242-0737
Fax Number	:

Provider Business Practice Location Address
First Line	:	5 HDSN VLY PROF PLZ
Second Line	:
City	:	NEWBURGH
State	:	NY
Zip	:	12550-3150
Country	:	US
Telephone Number	:	845-595-4775
Fax Number	:

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

Provider Enumeration Date	:	09/06/2018
Last Update Date	:	09/06/2018

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