Provider Demographics
NPI:1124586318
Name:VANCLEAVE, TREVA COLLETTE (PHD)
Entity Type:Individual
Prefix:
First Name:TREVA
Middle Name:COLLETTE
Last Name:VANCLEAVE
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 1:1236 UNION ST APT 1C
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11225-1638
Mailing Address - Country:US
Mailing Address - Phone:360-265-8598
Mailing Address - Fax:
Practice Address - Street 1:345 E 102ND ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10029-5611
Practice Address - Country:US
Practice Address - Phone:212-241-8462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-06
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist