Provider Demographics
NPI:1003097049
Name:RICKEMAN, ALEXANDRA (LCMFT)
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:
Last Name:RICKEMAN
Suffix:
Gender:F
Credentials:LCMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4623 FALLS RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-4914
Mailing Address - Country:US
Mailing Address - Phone:410-366-1980
Mailing Address - Fax:410-366-8530
Practice Address - Street 1:22 N COURT ST
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-5110
Practice Address - Country:US
Practice Address - Phone:410-876-1233
Practice Address - Fax:410-876-4791
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-19
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCM326106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1608463OtherCOVENTRY
MDT541-0091OtherCAREFIRST BCBS
MD2175630OtherCOMPSYCH
MD015851800Medicaid
MD211816OtherJOHNS HOPKINS HEALTHCARE
MD600467-811OtherMAGELLAN HEALTHCARE