MEDICARE: MS. CYNTHIA NORMAN RILEY LMT LPC

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	174400000X	Specialist	MSG008037	PA
2	101YP2500X	Professional Counselor	PC007940	PA

General Provider Information

NPI Number	:	1962819847
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CYNTHIA NORMAN RILEY LMT LPC

Provider Business Mailing Address
First Line	:	306 PINE ST
Second Line	:
City	:	WILLIAMSTOWN
State	:	NJ
Zip	:	08094-1139
Country	:	US
Telephone Number	:	443-941-4206
Fax Number	:	610-537-5043

Provider Business Practice Location Address
First Line	:	2801 ISLAND AVE STE 14
Second Line	:	FLOOR 1
City	:	PHILADELPHIA
State	:	PA
Zip	:	19153-2326
Country	:	US
Telephone Number	:	484-844-9890
Fax Number	:

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

Provider Enumeration Date	:	07/12/2014
Last Update Date	:	05/05/2019

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