MEDICARE: DR. RIVCKA EDELSTEIN PHD

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	103T00000X	Psychologist	8090-1	NY
2	103TB0200X	Cognitive & Behavioral Psychologist	8090-1	NY
3	103TC0700X	Clinical Psychologist	8090-1	NY
4	103TC2200X	Clinical Child & Adolescent Psychologist	8090-1	NY
5	103TF0000X	Family Psychologist	8090-1	NY
6	103TF0200X	Forensic Psychologist	8090-1	NY
7	106H00000X	Marriage & Family Therapist	8090-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	058472	OTHER	NY	VALUE OPTIONS
2	81182000	OTHER	NY	MAGELLAN BEHAVIORAL HEALT
3	V5332	OTHER	NY	EMPIRE BLUE CROSS

General Provider Information

NPI Number	:	1982820403
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RIVCKA EDELSTEIN PHD

Provider Business Mailing Address
First Line	:	125 PLEASANT ST APT 609
Second Line	:
City	:	BROOKLINE
State	:	MA
Zip	:	02446-7183
Country	:	US
Telephone Number	:	617-277-1961
Fax Number	:

Provider Business Practice Location Address
First Line	:	1394 STONY BROOK RD
Second Line	:
City	:	STONY BROOK
State	:	NY
Zip	:	11790-2205
Country	:	US
Telephone Number	:	617-429-8049
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/17/2007
Last Update Date	:	09/11/2025

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