Provider Demographics
NPI:1700038320
Name:RIMMA KOVALCIK,PSY.D. P.C.
Entity Type:Organization
Organization Name:RIMMA KOVALCIK,PSY.D. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RIMMA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOVALCIK
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:617-731-4081
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:
Practice Address - Street 1:1419 BEACON ST
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-4808
Practice Address - Country:US
Practice Address - Phone:617-731-4081
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-14
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7223103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
W50215Medicare PIN