Provider Demographics
NPI:1447403514
Name:SIVESIND, DAVID ERIC (PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ERIC
Last Name:SIVESIND
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 1:252 JAVA ST STE 323
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11222-5558
Mailing Address - Country:US
Mailing Address - Phone:917-627-1014
Mailing Address - Fax:
Practice Address - Street 1:252 JAVA ST STE 323
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11222-5558
Practice Address - Country:US
Practice Address - Phone:917-627-1014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-03
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018484103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical