Provider Demographics
NPI:1932345667
Name:RIFKIN, JAMIE BRETT (PHD)
Entity Type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:BRETT
Last Name:RIFKIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3210 TOLMAN HALL SPC 1650
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94720-1650
Mailing Address - Country:US
Mailing Address - Phone:312-961-4999
Mailing Address - Fax:
Practice Address - Street 1:3210 TOLMAN HALL SPC 1650
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94720-1650
Practice Address - Country:US
Practice Address - Phone:312-961-4999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-30
Last Update Date:2009-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071007570103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA22876OtherLICENSE
IL071007570OtherLICENSE