Lori Rieckelman, LCSW-C
Individual provider Active NPI Clinical Social Worker · Cabin John, MD
NPI 1154062172 · NPPES record last updated Apr 5, 2022
Key facts
- NPI
- 1154062172
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 4110 (MD)
- Practice address
- 6423 79TH St
Cabin John, MD 20818-1614 - Phone
- (301) 655-4404
- NPI assigned
- Apr 5, 2022
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Apr 2, 2022 through Apr 2, 2028
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 04110 | MD | MD | Psychologist |
| 4110 | MD | MD | Clinical Social Worker |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker |
1041C0700X | 4110 | MD | Yes |
Addresses
Primary practice location
6423 79TH St
Cabin John, MD 20818-1614
Mailing address
6423 79TH St
Cabin John, MD 20818-1614
Phone (301) 655-4404
Other providers in Cabin John, MD
- Pinnacle Reflections Therapeutic Services, LLC
- Potomac Pathways, LLC
- Andrew Nathan Rhein
- Harry Rieckelman
- Leela Deanne Rieckelman
- Rebecca Burkett Robison
- Alysa Romano
- Ethel Doris Sayles
- Rivon Shaneyfelt
- Barry Shapiro
All providers in Cabin John, MD · Clinical Social Worker in Maryland
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 5, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Opt Out Affidavits (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.