Provider Demographics
NPI:1649793985
Name:RIDDLE, ANNE MARIE (MS)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:MARIE
Last Name:RIDDLE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:MARIE
Other - Last Name:HEARY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:319 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:PA
Mailing Address - Zip Code:15857-1353
Mailing Address - Country:US
Mailing Address - Phone:814-512-5054
Mailing Address - Fax:724-972-4627
Practice Address - Street 1:319 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:PA
Practice Address - Zip Code:15857-1353
Practice Address - Country:US
Practice Address - Phone:814-512-5054
Practice Address - Fax:724-972-4627
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-19
Last Update Date:2019-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty