Provider Demographics
NPI:1760588008
Name:EIDEX, RIVKAH (PSYD)
Entity type:Individual
Prefix:DR
First Name:RIVKAH
Middle Name:
Last Name:EIDEX
Suffix:
Gender:
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6727 EVANSTON RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-3865
Mailing Address - Country:US
Mailing Address - Phone:404-641-3695
Mailing Address - Fax:
Practice Address - Street 1:6727 EVANSTON RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-3865
Practice Address - Country:US
Practice Address - Phone:404-641-3695
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2025-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD07277103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000000902217AMedicaid
GA68BBGBJMedicare ID - Type Unspecified