Provider Demographics
NPI:1033215173
Name:KOVALCIK, RIMMA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:RIMMA
Middle Name:
Last Name:KOVALCIK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:751 HEATH ST
Mailing Address - Street 2:
Mailing Address - City:CHESTNUT HILL
Mailing Address - State:MA
Mailing Address - Zip Code:02467-2200
Mailing Address - Country:US
Mailing Address - Phone:617-731-4081
Mailing Address - Fax:866-279-1297
Practice Address - Street 1:1180 BEACON ST
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-3885
Practice Address - Country:US
Practice Address - Phone:617-731-4081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7223103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0527114Medicaid
MA072230OtherTUFTS
MAW05743OtherBLUE CROSS/BLUE SHIELD
MA61-00319OtherEVERCARE
MA61-00319OtherEVERCARE
MAW50215Medicare ID - Type Unspecified