Healthcare Provider Details

I. General information

NPI: 1700038320
Provider Name (Legal Business Name): RIMMA KOVALCIK,PSY.D. P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2008
Last Update Date: 10/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1419 BEACON ST
BROOKLINE MA
02446-4808
US

IV. Provider business mailing address

751 HEATH ST
CHESTNUT HILL MA
02467-2200
US

V. Phone/Fax

Practice location:
  • Phone: 617-731-4081
  • Fax:
Mailing address:
  • Phone: 617-731-4081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number7223
License Number StateMA

VIII. Authorized Official

Name: RIMMA KOVALCIK
Title or Position: OWNER
Credential: PSY.D.
Phone: 617-731-4081