MEDICARE: DR. SIVAN SCHNEIDER PSYD

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	071009840	IL

General Provider Information

NPI Number	:	1730420787
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SIVAN SCHNEIDER PSYD

Provider Business Mailing Address
First Line	:	4669 N MANOR AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-3717
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 W BUENA AVE FL 2
Second Line	:	SMART LOVE FAMILY SERVICE
City	:	CHICAGO
State	:	IL
Zip	:	60613-1612
Country	:	US
Telephone Number	:	773-665-8052
Fax Number	:	708-660-4301

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

Provider Enumeration Date	:	03/14/2013
Last Update Date	:	06/09/2024

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