Provider Demographics
NPI:1811162571
Name:HARDESTY, RILEY (MS)
Entity type:Individual
Prefix:MRS
First Name:RILEY
Middle Name:
Last Name:HARDESTY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:379 6TH AVE W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34205-8820
Mailing Address - Country:US
Mailing Address - Phone:941-782-4100
Mailing Address - Fax:239-275-3103
Practice Address - Street 1:239 PETREL TRL
Practice Address - Street 2:
Practice Address - City:LAKEWOOD RANCH
Practice Address - State:FL
Practice Address - Zip Code:34212-2995
Practice Address - Country:US
Practice Address - Phone:239-791-1508
Practice Address - Fax:239-275-3103
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-24
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health