Provider Demographics
NPI:1205370871
Name:SIVAN, GAL (PSYD)
Entity Type:Individual
Prefix:
First Name:GAL
Middle Name:
Last Name:SIVAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 BRAINERD RD
Mailing Address - Street 2:APT 311
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02134-4527
Mailing Address - Country:US
Mailing Address - Phone:617-939-3864
Mailing Address - Fax:
Practice Address - Street 1:1330 BEACON ST
Practice Address - Street 2:# 202
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-3282
Practice Address - Country:US
Practice Address - Phone:617-580-0888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-15
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10508103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical