Provider Information for 1639317001
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JUANITA L RILEY LMHC
Sex: Female
NPI: 1639317001
Last Updated: 2009-01-23
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1639317001 | ||||||||||||||||
| Enumeration Date | 2009-01-23 | ||||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||||
| Sole Proprietor | NO | ||||||||||||||||
| Status | Active | ||||||||||||||||
| Mailing Address | 5152 LIGHTHOUSE RD ORLANDO, FL 32808-1626 United States Phone: 407-404-2357 | Fax:407-291-1402 | ||||||||||||||||
| Primary Practice Address | 2917 N PINE HILLS RD ORLANDO, FL 32808-3539 United States Phone: 407-398-6676 | Fax:407-291-1402 | ||||||||||||||||
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