Provider Demographics
NPI:1346342896
Name:RILEY, TARRON D (LCSW)
Entity type:Individual
Prefix:
First Name:TARRON
Middle Name:D
Last Name:RILEY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 245
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92393-0245
Mailing Address - Country:US
Mailing Address - Phone:760-403-1414
Mailing Address - Fax:760-962-0025
Practice Address - Street 1:16519 VICTOR ST
Practice Address - Street 2:SUITE 406
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-3965
Practice Address - Country:US
Practice Address - Phone:760-403-1414
Practice Address - Fax:760-962-0025
Is Sole Proprietor?:No
Enumeration Date:2006-09-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 234661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical