Provider Demographics
NPI:1386116119
Name:RILEY, KALI (LSW)
Entity type:Individual
Prefix:MRS
First Name:KALI
Middle Name:
Last Name:RILEY
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5155 ROSEBUD LN
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:IN
Mailing Address - Zip Code:47630-9332
Mailing Address - Country:US
Mailing Address - Phone:812-773-8321
Mailing Address - Fax:812-993-1846
Practice Address - Street 1:5155 ROSEBUD LN
Practice Address - Street 2:
Practice Address - City:NEWBURGH
Practice Address - State:IN
Practice Address - Zip Code:47630-9332
Practice Address - Country:US
Practice Address - Phone:812-773-8321
Practice Address - Fax:812-993-1846
Is Sole Proprietor?:No
Enumeration Date:2018-12-18
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33008869A104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN33008869AOtherLICENSE