Provider Demographics
NPI:1417370446
Name:RIVKA SIDORSKY, LLC
Entity Type:Organization
Organization Name:RIVKA SIDORSKY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MIEKE
Authorized Official - Middle Name:RIVKA
Authorized Official - Last Name:SIDORSKY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:301-244-8052
Mailing Address - Street 1:8555 16TH ST STE 204
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-2854
Mailing Address - Country:US
Mailing Address - Phone:301-244-8052
Mailing Address - Fax:
Practice Address - Street 1:8555 16TH ST STE 204
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-2854
Practice Address - Country:US
Practice Address - Phone:301-244-8052
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-27
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD162161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty