Provider Demographics
NPI:1083124705
Name:EVANS, MARCIE ANN (LMFT)
Entity Type:Individual
Prefix:MS
First Name:MARCIE
Middle Name:ANN
Last Name:EVANS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:MARCIE
Other - Middle Name:ANN
Other - Last Name:EVANS SCHULMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:30 PARK AVE APT 11M
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-3836
Mailing Address - Country:US
Mailing Address - Phone:917-301-1474
Mailing Address - Fax:
Practice Address - Street 1:30 PARK AVE APT 11M
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-3836
Practice Address - Country:US
Practice Address - Phone:917-301-1474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-08
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000890106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty