Provider Demographics
NPI:1124842661
Name:RILEY, CAITLYN C
Entity type:Individual
Prefix:
First Name:CAITLYN
Middle Name:C
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 1:405 N HUBERT AVE APT 202
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-2110
Mailing Address - Country:US
Mailing Address - Phone:763-639-1743
Mailing Address - Fax:763-639-1743
Practice Address - Street 1:405 N HUBERT AVE APT 202
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-2110
Practice Address - Country:US
Practice Address - Phone:763-639-1743
Practice Address - Fax:763-639-1743
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-12
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst