Provider Demographics
NPI:1326183245
Name:VANCLEAVE, NANCY JEANNE (MA)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:JEANNE
Last Name:VANCLEAVE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5754 SEELEY RD
Mailing Address - Street 2:
Mailing Address - City:CAYUTA
Mailing Address - State:NY
Mailing Address - Zip Code:14824-9733
Mailing Address - Country:US
Mailing Address - Phone:607-594-2286
Mailing Address - Fax:
Practice Address - Street 1:110 HO PLAZA
Practice Address - Street 2:CORNELL UNIVERSITY
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14853-3101
Practice Address - Country:US
Practice Address - Phone:607-255-5208
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00000066106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist