Provider Demographics
NPI:1063390938
Name:DUVAL, TREVOR ANTHONY
Entity type:Individual
Prefix:
First Name:TREVOR
Middle Name:ANTHONY
Last Name:DUVAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3741 SW MANAK ST
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-7706
Mailing Address - Country:US
Mailing Address - Phone:772-302-7324
Mailing Address - Fax:
Practice Address - Street 1:3741 SW MANAK ST
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-7706
Practice Address - Country:US
Practice Address - Phone:772-302-7324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-26
Last Update Date:2025-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician