Provider Demographics
NPI:1063544351
Name:SIVAN, EVA D (PHD)
Entity type:Individual
Prefix:DR
First Name:EVA
Middle Name:D
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 1:1811 SNOW MEADOW LN
Mailing Address - Street 2:#201
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-1349
Mailing Address - Country:US
Mailing Address - Phone:443-629-6297
Mailing Address - Fax:
Practice Address - Street 1:1811 SNOW MEADOW LN
Practice Address - Street 2:#201
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21209-1349
Practice Address - Country:US
Practice Address - Phone:443-629-6297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD2648103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist