Provider Demographics
NPI:1083648554
Name:CHEUVRONT, JEFFRE PHILLIP JR (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JEFFRE
Middle Name:PHILLIP
Last Name:CHEUVRONT
Suffix:JR
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:63 E 9TH ST
Mailing Address - Street 2:APT 11F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-6302
Mailing Address - Country:US
Mailing Address - Phone:212-352-8599
Mailing Address - Fax:
Practice Address - Street 1:200 W 20TH ST
Practice Address - Street 2:SUITE 104
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-3558
Practice Address - Country:US
Practice Address - Phone:212-352-8599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2011-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013557103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01863670Medicaid
NYV93591Medicare ID - Type Unspecified