Provider Demographics
NPI:1174116743
Name:RILEY, CARLY RUTH (MSW)
Entity type:Individual
Prefix:MRS
First Name:CARLY
Middle Name:RUTH
Last Name:RILEY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6217 PADDOCK GLEN DR UNIT 102
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-5349
Mailing Address - Country:US
Mailing Address - Phone:703-638-0035
Mailing Address - Fax:
Practice Address - Street 1:1501 S PINELLAS AVE STE C
Practice Address - Street 2:
Practice Address - City:TARPON SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34689-1950
Practice Address - Country:US
Practice Address - Phone:703-638-0035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-15
Last Update Date:2021-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL151771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical