Provider Demographics
NPI:1295921575
Name:RIEBMAN, JEFFREY ERIC
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:ERIC
Last Name:RIEBMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:JEFFREY
Other - Middle Name:E
Other - Last Name:RIEBMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW-C
Mailing Address - Street 1:810 HYDE CT
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-3042
Mailing Address - Country:US
Mailing Address - Phone:301-509-1581
Mailing Address - Fax:301-649-5403
Practice Address - Street 1:912 THAYER AVE
Practice Address - Street 2:SUITE 209
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-4570
Practice Address - Country:US
Practice Address - Phone:301-509-1581
Practice Address - Fax:301-649-5403
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD107741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD10774OtherDEPT HEALTH&MENTAL HYG.