Provider Demographics
NPI:1003020728
Name:RAVIV, DAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:DAN
Middle Name:
Last Name:RAVIV
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 1:1051 FENWOOD DR
Mailing Address - Street 2:#3
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-2412
Mailing Address - Country:US
Mailing Address - Phone:516-812-6672
Mailing Address - Fax:
Practice Address - Street 1:133 W 25TH ST
Practice Address - Street 2:#3
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-7206
Practice Address - Country:US
Practice Address - Phone:516-695-3925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000276101YM0800X
NY000571102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst