Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 73084307 | NY |
NPI | 1003153669 |
---|---|
Provider Name | Julie A Riley |
First Address | Newburgh, NY 12550-1910 |
Second Address | Newburgh, NY 12550-3744 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/01/2013 |
Last Update Date | 20/04/2016 |