Provider Demographics
NPI:1619666328
Name:RILEY, EMMETT (EDD, LICENSED MSW)
Entity type:Individual
Prefix:
First Name:EMMETT
Middle Name:
Last Name:RILEY
Suffix:
Gender:M
Credentials:EDD, LICENSED MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5312 ARTHUR ST
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-1334
Mailing Address - Country:US
Mailing Address - Phone:219-789-6806
Mailing Address - Fax:
Practice Address - Street 1:6111 HARRISON ST
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-2969
Practice Address - Country:US
Practice Address - Phone:219-576-2662
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-08
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN33003811A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical