MEDICARE: RIVKA SIDORSKY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	16216	MD

General Provider Information

NPI Number	:	1417370446
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIVKA SIDORSKY, LLC

Provider Business Mailing Address
First Line	:	8555 16TH ST STE 204
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20910-2854
Country	:	US
Telephone Number	:	301-244-8052
Fax Number	:

Provider Business Practice Location Address
First Line	:	8555 16TH ST STE 204
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20910-2854
Country	:	US
Telephone Number	:	301-244-8052
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. MIEKE RIVKA SIDORSKY
Credential	:	LCSW-C
Telephone Number	:	301-244-8052

Provider Enumeration Date	:	01/27/2014
Last Update Date	:	01/08/2021

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