Provider Demographics
NPI:1437469517
Name:RILEY, WILLIAM PATRICK (MA)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:PATRICK
Last Name:RILEY
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2477 SCOTTVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32725-2224
Mailing Address - Country:US
Mailing Address - Phone:321-287-8089
Mailing Address - Fax:
Practice Address - Street 1:665 W WARREN AVE
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-4004
Practice Address - Country:US
Practice Address - Phone:321-287-8089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-07
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH8908101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health