Provider Demographics
NPI:1427493337
Name:RILEY, JOANNA (MSED, BCBA)
Entity type:Individual
Prefix:MRS
First Name:JOANNA
Middle Name:
Last Name:RILEY
Suffix:
Gender:F
Credentials:MSED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:440 AVENUE P
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-1935
Mailing Address - Country:US
Mailing Address - Phone:718-376-5510
Mailing Address - Fax:
Practice Address - Street 1:440 AVENUE P
Practice Address - Street 2:2ND FLOOR
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-1935
Practice Address - Country:US
Practice Address - Phone:718-376-5510
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-06
Last Update Date:2015-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1-12-12412103K00000X
1077969174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst