Healthcare Provider Details

I. General information

NPI: 1154230498
Provider Name (Legal Business Name): CHAVA ARIEL CREQUE PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 FORT WASHINGTON AVE
NEW YORK NY
10040-3905
US

IV. Provider business mailing address

660 FORT WASHINGTON AVE APT 5E
NEW YORK NY
10040-3908
US

V. Phone/Fax

Practice location:
  • Phone: 212-498-8864
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number027656
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: