Provider Demographics
NPI:1245191618
Name:RILEY, SIDNEY (BCBA)
Entity type:Individual
Prefix:
First Name:SIDNEY
Middle Name:
Last Name:RILEY
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3985 W 1960 N
Mailing Address - Street 2:
Mailing Address - City:LEHI
Mailing Address - State:UT
Mailing Address - Zip Code:84048-7031
Mailing Address - Country:US
Mailing Address - Phone:505-218-6542
Mailing Address - Fax:
Practice Address - Street 1:2315 SAN PEDRO DR NE STE F10
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-4158
Practice Address - Country:US
Practice Address - Phone:505-218-6542
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-11-24
Last Update Date:2025-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT1-23-64256103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst