Provider Demographics
NPI:1114957529
Name:EVANS, GEOFFREY F (PHD)
Entity Type:Individual
Prefix:
First Name:GEOFFREY
Middle Name:F
Last Name:EVANS
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 1:18 LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-7169
Mailing Address - Country:US
Mailing Address - Phone:207-729-8457
Mailing Address - Fax:
Practice Address - Street 1:18 LINCOLN ST
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-7169
Practice Address - Country:US
Practice Address - Phone:207-729-8457
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS416103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME003184OtherANTHEM
ME703657Medicare PIN