Provider Demographics
NPI:1407411291
Name:KNOWLES, TRIVETTE
Entity Type:Individual
Prefix:
First Name:TRIVETTE
Middle Name:
Last Name:KNOWLES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:387 EASTERN PKWY APT 27
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11216-4800
Mailing Address - Country:US
Mailing Address - Phone:913-961-4034
Mailing Address - Fax:
Practice Address - Street 1:387 EASTERN PKWY APT 27
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11216-4800
Practice Address - Country:US
Practice Address - Phone:913-961-4034
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-07
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst