Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | 5168551 | NJ |
NPI | 1003396300 |
---|---|
Provider Name | Ms. Coswaylo E Riley |
First Address | Sicklerville, NJ 08081 |
Second Address | Sicklerville, NJ 08081 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2018 |
Last Update Date | 16/08/2018 |