Provider Demographics
NPI:1598970527
Name:SIVIN, PHYLLIS L (LCSWR)
Entity Type:Individual
Prefix:MS
First Name:PHYLLIS
Middle Name:L
Last Name:SIVIN
Suffix:
Gender:F
Credentials:LCSWR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:289 BALTIC ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-6404
Mailing Address - Country:US
Mailing Address - Phone:347-414-6396
Mailing Address - Fax:
Practice Address - Street 1:41 E 11TH ST
Practice Address - Street 2:FOURTH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4602
Practice Address - Country:US
Practice Address - Phone:347-414-6396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0519601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCHHQ11554548OtherPSYCHOTHERAPY