Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | 000276 | NY |
N | 102L00000X | Psychologist | 000571 | NY |
N | 103T00000X | Psychologist | 000571 | NY |
NPI | 1003020728 |
---|---|
Provider Name | Dr. Dan Raviv |
First Address | Valley Stream, NY 11580-2412 |
Second Address | New York, NY 10001-7206 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2007 |
Last Update Date | 11/06/2010 |