Provider Demographics
NPI:1609057827
Name:RIEKERT, KRISTIN ALYCE (PHD)
Entity Type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:ALYCE
Last Name:RIEKERT
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5501 HOPKINS BAYVIEW CIR
Mailing Address - Street 2:JHAAC 4B.72
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-6821
Mailing Address - Country:US
Mailing Address - Phone:410-550-7755
Mailing Address - Fax:410-550-2612
Practice Address - Street 1:5501 HOPKINS BAYVIEW CIR
Practice Address - Street 2:JHAAC 4B.72
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-6821
Practice Address - Country:US
Practice Address - Phone:410-550-7755
Practice Address - Fax:410-550-2612
Is Sole Proprietor?:No
Enumeration Date:2007-11-15
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03783103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical