Provider Demographics
NPI:1801834270
Name:OLLEY, RIVKA ISABELLE (PH D)
Entity Type:Individual
Prefix:DR
First Name:RIVKA
Middle Name:ISABELLE
Last Name:OLLEY
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:DR
Other - First Name:RIVKA
Other - Middle Name:ISABELL
Other - Last Name:OLLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PH D
Mailing Address - Street 1:120 SISTER PIERRE DRIVE
Mailing Address - Street 2:SUITE 403
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204
Mailing Address - Country:US
Mailing Address - Phone:410-825-6408
Mailing Address - Fax:443-279-0537
Practice Address - Street 1:120 SISTER PIERRE DRIVE
Practice Address - Street 2:SUITE 403
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204
Practice Address - Country:US
Practice Address - Phone:410-825-6408
Practice Address - Fax:443-279-0537
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03668103TC1900X
MD103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
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StateIdentifier IDID TypeIssuer
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2136797OtherMAMS INDIVIDUAL
252450OtherCOMP GROUP
64518601OtherBSMP INDIVIDUAL
2512798OtherUNHC GROUP
362174OtherMHN INDIVIDUAL
555465OtherUNHC INDIVIDUAL
705BPSOtherBSMD GROUP
K452OtherBSDC GROUP
0023OtherBSDC INDIVIDUAL
102223OtherTRI INDIVIDUAL
150N117GOtherMBMD INDIVIDUAL
249586OtherCOMP INDIVIDUAL
150NOtherMBMD GROUP
360218OtherMHN GROUP