Basic Information
| Provider Information | |||||||||
| NPI: | 1811263007 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BEN DOR | ||||||||
| FirstName: | RIVKA | ||||||||
| MiddleName: | RIVI | ||||||||
| NamePrefix: | DR. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 22616 GATEWAY CENTER DR | ||||||||
| Address2: | SUITE E | ||||||||
| City: | CLARKSBURG | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208712011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2408268600 | ||||||||
| FaxNumber: | 2408268610 | ||||||||
| Practice Location | |||||||||
| Address1: | 14915 BROSCHART RD STE 2200 | ||||||||
| Address2: | |||||||||
| City: | ROCKVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208503350 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3018384912 | ||||||||
| FaxNumber: | 3012514666 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/01/2012 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | D0080747 | MD | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 261QM0850X | D0080747 | MD | N | Ambulatory Health Care Facilities | Clinic/Center | Adult Mental Health |
No ID Information.