| Dr. Donna Riley Office Of Licensed Clinical Social Work, Pllc | |
|
2233 Nesconset Hwy Ste 100 Lake Grove NY 11755-1000 | |
| (631) 602-7856 | |
| (631) 602-7857 |
| Full Name | Dr. Donna Riley Office Of Licensed Clinical Social Work, Pllc |
|---|---|
| Speciality | Social Worker |
| Location | 2233 Nesconset Hwy Ste 100, Lake Grove, New York |
| Authorized Official Name and Position | Donna Barbara Riley (CEO) |
| Authorized Official Contact | 5169831780 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dr. Donna Riley Office Of Licensed Clinical Social Work, Pllc 2233 Nesconset Hwy Ste 100 Lake Grove NY 11755-1000 Ph: (631) 602-7856 | Dr. Donna Riley Office Of Licensed Clinical Social Work, Pllc 2233 Nesconset Hwy Ste 100 Lake Grove NY 11755-1000 Ph: (631) 602-7856 |
| NPI Number | 1811649833 |
|---|---|
| Provider Enumeration Date | 01/20/2022 |
| Last Update Date | 02/01/2022 |
| Certification Date | 01/26/2022 |
| Medicare PECOS PAC ID | 6507253754 |
|---|---|
| Medicare Enrollment ID | O20220419000320 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811649833 | NPI | - | NPPES |
| 03364918 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Kevin Michael Lycke |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1770894511 PECOS PAC ID: 6406972587 Enrollment ID: I20100927000319 |
| Provider Name | Donna B Riley |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1508020611 PECOS PAC ID: 5597938951 Enrollment ID: I20111031000190 |
| Provider Name | Andrea C Cuttler |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1053560532 PECOS PAC ID: 5294034708 Enrollment ID: I20160505000845 |
| Provider Name | Jennifer Fazio |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1245635259 PECOS PAC ID: 6608235429 Enrollment ID: I20230711002002 |
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