Provider Demographics
NPI:1417004755
Name:SAMET, AVIVA ESTHER (PSYD)
Entity Type:Individual
Prefix:DR
First Name:AVIVA
Middle Name:ESTHER
Last Name:SAMET
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 1:333 N MICHIGAN AVE
Mailing Address - Street 2:SUITE 801
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-3901
Mailing Address - Country:US
Mailing Address - Phone:312-424-2642
Mailing Address - Fax:312-337-5996
Practice Address - Street 1:333 N MICHIGAN AVE
Practice Address - Street 2:SUITE 801
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60601-3901
Practice Address - Country:US
Practice Address - Phone:312-424-2642
Practice Address - Fax:312-337-5996
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL01626908OtherBCBS OF IL
IL200745Medicare ID - Type Unspecified