Provider Demographics
NPI:1225546781
Name:LEMMA, EVAN
Entity Type:Individual
Prefix:
First Name:EVAN
Middle Name:
Last Name:LEMMA
Suffix:
Gender:M
Credentials:
Other - Prefix:MISS
Other - First Name:EVE
Other - Middle Name:
Other - Last Name:LEMMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10 SOUTH RD
Mailing Address - Street 2:
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-4502
Mailing Address - Country:US
Mailing Address - Phone:203-521-8028
Mailing Address - Fax:
Practice Address - Street 1:444 CENTER ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040-3926
Practice Address - Country:US
Practice Address - Phone:860-646-3888
Practice Address - Fax:860-645-4132
Is Sole Proprietor?:No
Enumeration Date:2018-01-18
Last Update Date:2019-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health