Provider Demographics
NPI:1801519756
Name:GRANT, CHEVANESE V (MS SPECIAL EDUCATION)
Entity type:Individual
Prefix:MS
First Name:CHEVANESE
Middle Name:V
Last Name:GRANT
Suffix:
Gender:F
Credentials:MS SPECIAL EDUCATION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 GLENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-3602
Mailing Address - Country:US
Mailing Address - Phone:914-336-1512
Mailing Address - Fax:
Practice Address - Street 1:1336 LOUIS NINE BLVD
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10459-1535
Practice Address - Country:US
Practice Address - Phone:718-991-2119
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2588463103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty