Provider Demographics
NPI:1528304326
Name:RILEY, SUSAN (LCSW, MS)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:RILEY
Suffix:
Gender:F
Credentials:LCSW, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 E GATE LN
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06514-2232
Mailing Address - Country:US
Mailing Address - Phone:203-535-2888
Mailing Address - Fax:203-288-7358
Practice Address - Street 1:101 E GATE LN
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06514-2232
Practice Address - Country:US
Practice Address - Phone:203-535-2888
Practice Address - Fax:203-288-7358
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-26
Last Update Date:2017-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0059621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical