Provider Demographics
NPI:1790836278
Name:TREVVETT, BARBARA
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:TREVVETT
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 1:471 GRANT RD
Mailing Address - Street 2:
Mailing Address - City:COLD BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:13324-2510
Mailing Address - Country:US
Mailing Address - Phone:315-826-7677
Mailing Address - Fax:
Practice Address - Street 1:1 ELLINWOOD CT
Practice Address - Street 2:
Practice Address - City:NEW HARTFORD
Practice Address - State:NY
Practice Address - Zip Code:13413-1100
Practice Address - Country:US
Practice Address - Phone:315-736-4485
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000047-1106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist