Provider Demographics
NPI:1851629760
Name:ZIVIN, GAIL (PHD)
Entity Type:Individual
Prefix:DR
First Name:GAIL
Middle Name:
Last Name:ZIVIN
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 1:217 BARREN HILL RD
Mailing Address - Street 2:
Mailing Address - City:CONSHOHOCKEN
Mailing Address - State:PA
Mailing Address - Zip Code:19428-2403
Mailing Address - Country:US
Mailing Address - Phone:215-233-9127
Mailing Address - Fax:
Practice Address - Street 1:1213 BETHLEHEM PIKE
Practice Address - Street 2:SUITE 7
Practice Address - City:FLOURTOWN
Practice Address - State:PA
Practice Address - Zip Code:19031-1941
Practice Address - Country:US
Practice Address - Phone:215-233-9127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-04
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS0003239L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist