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General NPI Number Information
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NPI Number | 1700038320
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Entity Type | Organization
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Legal Business Name | RIMMA KOVALCIK,PSY.D. P.C.
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Dates
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Enumeration Date | 10/14/2008
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Last Update Date | 10/14/2008
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Provider Practice Location Address
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Address Line | 1419 BEACON ST
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City | BROOKLINE
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State | MA
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Zip | 02446-4808
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Country | US
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Telephone | 617-731-4081
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Fax |
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Provider Business Mailing Address
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Address Line | 751 HEATH ST
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City | CHESTNUT HILL
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State | MA
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Zip | 02467-2200
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Country | US
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Telephone | 617-731-4081
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | RIMMA KOVALCIK
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Credential | PSY.D.
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Telephone | 617-731-4081
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 7223
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License Number State | MA
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