Provider Demographics
NPI:1710403506
Name:LUKE, CHAVONE RE
Entity Type:Individual
Prefix:
First Name:CHAVONE
Middle Name:RE
Last Name:LUKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 DREW ST APT 311
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11208-5150
Mailing Address - Country:US
Mailing Address - Phone:347-975-8967
Mailing Address - Fax:
Practice Address - Street 1:901 DREW ST APT 311
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11208-5150
Practice Address - Country:US
Practice Address - Phone:347-975-8967
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-14
Last Update Date:2017-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician