Provider Demographics
NPI:1629191507
Name:RAVIV, NIRIT (PHD)
Entity Type:Individual
Prefix:DR
First Name:NIRIT
Middle Name:
Last Name:RAVIV
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:933 SUTTON DR
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-3017
Mailing Address - Country:US
Mailing Address - Phone:847-272-7647
Mailing Address - Fax:
Practice Address - Street 1:933 SUTTON DR
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-3017
Practice Address - Country:US
Practice Address - Phone:847-272-7647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-07
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