MEDICARE: DR. DAVID ERIC SIVESIND PHD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	018484	NY

General Provider Information

NPI Number	:	1447403514
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID ERIC SIVESIND PHD

Provider Business Mailing Address
First Line	:	252 JAVA ST STE 323
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11222-5558
Country	:	US
Telephone Number	:	917-627-1014
Fax Number	:

Provider Business Practice Location Address
First Line	:	252 JAVA ST STE 323
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11222-5558
Country	:	US
Telephone Number	:	917-627-1014
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/03/2008
Last Update Date	:	03/10/2023

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