Most Relevant Information
Provider Data
| NPI Number: | 1003432196 |
| Provider Name: | THERESA EAVES |
| Entity Type: | Individual |
| Taxonomy Code: | 101YM0800X |
| Specialty: | Counselor |
| License Number: |
Most Important Dates
| Enumeration Date: | 06/24/2020 |
| Last Updated: | 07/02/2020 |
Provider Practice Location
410 E JERICHO TPKE
MINEOLA
NY
115012112
Practice Location Phone/Fax
| Phone: | 3476876616 |
| Fax: |
Provider Mailing Location
192 THROOP AVE APT 1
BROOKLYN
NY
112065334
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |