Individual
ASHMODEL RILEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
111 SOUTH ST, SOMERVILLE, MA 02143-4297
(617) 659-3020
Mailing address
111 SOUTH ST, SOMERVILLE, MA 02143-4297
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
043097170
—
MA
Enumeration date
05/24/2018
Last updated
05/24/2018
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