Provider Demographics
NPI:1073894838
Name:EVATT, DANIEL P (PHD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:P
Last Name:EVATT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1229
Mailing Address - Street 2:
Mailing Address - City:SYKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21784-1229
Mailing Address - Country:US
Mailing Address - Phone:410-549-3196
Mailing Address - Fax:410-549-3197
Practice Address - Street 1:1311 LONDONTOWN BLVD
Practice Address - Street 2:SUITE 130A
Practice Address - City:ELDERSBURG
Practice Address - State:MD
Practice Address - Zip Code:21784-6454
Practice Address - Country:US
Practice Address - Phone:410-552-0773
Practice Address - Fax:410-549-3197
Is Sole Proprietor?:No
Enumeration Date:2011-09-07
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04857103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical