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General NPI Number Information
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NPI Number | 1598575045
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Entity Type | Individual
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Provider Name | MISS RIVKAH MASADA GOURDJI
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Gender | Female
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Dates
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Enumeration Date | 01/08/2025
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Last Update Date | 01/08/2025
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Provider Practice Location Address
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Address Line | 2501 SMITH AVE
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City | BALTIMORE
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State | MD
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Zip | 21209-2505
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Country | US
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Telephone | 410-205-9493
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Fax | 301-384-7191
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Provider Business Mailing Address
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Address Line | 6605 EDENVALE RD
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City | BALTIMORE
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State | MD
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Zip | 21209-2701
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Country | US
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Telephone | 206-280-8068
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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