Provider Demographics
NPI:1972601441
Name:RISHIKOF, JAMIE R (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:R
Last Name:RISHIKOF
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:965 CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON UPPER FALLS
Mailing Address - State:MA
Mailing Address - Zip Code:02464-1101
Mailing Address - Country:US
Mailing Address - Phone:617-964-5508
Mailing Address - Fax:
Practice Address - Street 1:8 GROVE ST
Practice Address - Street 2:SUITE 305
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02482-7797
Practice Address - Country:US
Practice Address - Phone:781-237-4343
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7986103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist