Provider Demographics
NPI:1104436328
Name:RILEY, EMILY PAIGE
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:PAIGE
Last Name:RILEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W 70TH ST APT 8D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-4325
Mailing Address - Country:US
Mailing Address - Phone:631-356-2273
Mailing Address - Fax:
Practice Address - Street 1:71 W 23RD ST STE 704
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-4299
Practice Address - Country:US
Practice Address - Phone:212-576-4104
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-03
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY105692-01101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health