Doctor Name: | TRACY M RILEY |
NPI Number: | 1679762553 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MSW |
License Number: | ISW 4412 |
Business Practice Address: | 808 3rd St Suite C Neptune Beach, FL - 322665081 |
Business Phone Number: | 9047042527 |
Business Fax Number: | |
Mailing Address: | 808 3rd St, Suite C NEPTUNE BEACH |
State: | FL |
Postal Code: | 322665081 |
Phone Number: | 9047042527 |
Fax Number: | |
NPI Enumeration Date: | 10/17/2007 |
NPI Last Update Date: | 08/09/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | ISW 4412 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | FL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |