Provider Demographics
NPI:1548861834
Name:RILEY, NATALIE M (LCSW)
Entity type:Individual
Prefix:MRS
First Name:NATALIE
Middle Name:M
Last Name:RILEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:NATALIE
Other - Middle Name:M
Other - Last Name:PACELLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:1558 BARNUM AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06610-3238
Mailing Address - Country:US
Mailing Address - Phone:203-384-3377
Mailing Address - Fax:203-378-8578
Practice Address - Street 1:1558 BARNUM AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06610-3238
Practice Address - Country:US
Practice Address - Phone:203-384-3377
Practice Address - Fax:203-378-8578
Is Sole Proprietor?:No
Enumeration Date:2020-11-04
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0100311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical