Individual
KEITH RILEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
30 DANFORTH ST STE 311, PORTLAND, ME 04101-4574
(207) 774-6877
(207) 879-0761
Mailing address
30 DANFORTH ST STE 311, PORTLAND, ME 04101-4574
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
LC14061
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1992935662
—
ME
Enumeration date
07/23/2015
Last updated
07/23/2015
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