Provider Demographics
NPI:1063616852
Name:RIES, MARIA T (LCSW)
Entity type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:T
Last Name:RIES
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:LEZA
Other - Middle Name:
Other - Last Name:RIES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:1111 S FLORIDA AVE
Mailing Address - Street 2:
Mailing Address - City:TARPON SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34689-2949
Mailing Address - Country:US
Mailing Address - Phone:727-945-9735
Mailing Address - Fax:
Practice Address - Street 1:2270 DREW ST
Practice Address - Street 2:SUITE C
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-3344
Practice Address - Country:US
Practice Address - Phone:727-784-8244
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 53951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical