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General NPI Number Information
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NPI Number | 1154803229
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Entity Type | Individual
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Provider Name | MRS. STACY RIVKIN
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Gender | Female
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Dates
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Enumeration Date | 09/05/2018
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Last Update Date | 09/05/2018
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Provider Practice Location Address
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Address Line | 2401 W BELVEDERE AVE
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City | BALTIMORE
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State | MD
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Zip | 21215-5216
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Country | US
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Telephone | 410-601-1280
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Fax |
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Provider Business Mailing Address
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Address Line | 282 CEDARMERE CIR
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City | OWINGS MILLS
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State | MD
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Zip | 21117-2446
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Country | US
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Telephone | 410-370-5554
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 21833
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License Number State | MD
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