Provider Demographics
NPI:1164703146
Name:JEFFREY-RIGGINS, MONIFA S (MSW, LCSWC)
Entity Type:Individual
Prefix:MS
First Name:MONIFA
Middle Name:S
Last Name:JEFFREY-RIGGINS
Suffix:
Gender:F
Credentials:MSW, LCSWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5730 COTTONWORTH AVE
Mailing Address - Street 2:UNIT 5389
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-7500
Mailing Address - Country:US
Mailing Address - Phone:443-845-3514
Mailing Address - Fax:
Practice Address - Street 1:512 ORCHARD ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1947
Practice Address - Country:US
Practice Address - Phone:443-845-3514
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-02
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD123921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD443343200Medicaid
BF10-0001OtherCAREFIRST BCBS