Provider Demographics
NPI:1023093515
Name:SIVAN, ABIGAIL BENTON (PHD)
Entity type:Individual
Prefix:DR
First Name:ABIGAIL
Middle Name:BENTON
Last Name:SIVAN
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 1:2000 DEWES ST
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-4239
Mailing Address - Country:US
Mailing Address - Phone:847-486-1492
Mailing Address - Fax:847-730-3003
Practice Address - Street 1:3330 OLD GLENVIEW RD
Practice Address - Street 2:SUITE 5
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-2963
Practice Address - Country:US
Practice Address - Phone:847-251-3261
Practice Address - Fax:847-730-3003
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00431103T00000X
IA00092103TH0100X
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical