Individual provider Active NPI

Roger Riley, LMHC, LCPC

  • Mental Health Counselor
  • Annapolis, MD
National Provider Identifier
1679786388
Registry record updated Aug 13, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
MH15872 Issued in FL
Practice address
5 Oak CT
Annapolis, MD 21401-7017
Phone
(443) 310-8753
NPI assigned
May 8, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 13, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X LC2042 MD
Mental Health Counselor 101YM0800X MH15872 FL Primary

Addresses

Primary practice location

5 Oak CT
Annapolis, MD 21401-7017

Mailing address

612 NE 22ND Dr
Wilton Manors, FL 33305-2118
Phone (443) 310-8753

Other practice location 1

612 NE 22nd Dr
Wilton Manors, FL 33305-2118
Phone (443) 310-8753

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL, MD2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20240221001022 FL Practitioner - Mental Health Counselor 6709193212 Practice locations: Wilton Manors, FL
I20240830003175 MD Practitioner - Mental Health Counselor 6709193212 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2000
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services
Group practices
Interventions, LLCGroup PAC ID 9032426549, 4 clinicians

Practice addresses (Care Compare)

5 Oak CT
Annapolis, MD 21401-7017
Phone (410) 266-3040

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
MH15872FLMDMental Health Counselor
LC2042MDMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Interventions, LLC CurrentSince Aug 16, 2024 Accepting new patients
Interventions-FL Mental Health CurrentSince Jul 21, 2024 Accepting new patients
Interventions, LLC Past Accepting new patients
Interventions, LLC Past Accepting new patients

Locations

5 Oak Ct
Annapolis, MD 21401
Phone (410) 266-3040

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1178582400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723507200000",
    "number": "1679786388",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "612 NE 22ND DR",
            "city": "WILTON MANORS",
            "state": "FL",
            "postal_code": "333052118",
            "telephone_number": "443-310-8753",
            "fax_number": "443-378-3540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5 OAK CT",
            "city": "ANNAPOLIS",
            "state": "MD",
            "postal_code": "214017017",
            "telephone_number": "443-310-8753"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "612 NE 22nd Dr",
            "address_purpose": "LOCATION",
            "city": "Wilton Manors",
            "state": "FL",
            "postal_code": "333052118",
            "country_code": "US",
            "telephone_number": "443-310-8753",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RILEY",
        "first_name": "ROGER",
        "credential": "LMHC, LCPC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-08",
        "last_updated": "2024-08-13",
        "certification_date": "2024-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "MD",
            "license": "LC2042",
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "MH15872",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Annapolis, MD

Sources for this page

Verify at the official NPI Registry.