Provider Demographics
NPI:1275391344
Name:JEWETT, EVAN MONET (RBT)
Entity Type:Individual
Prefix:
First Name:EVAN
Middle Name:MONET
Last Name:JEWETT
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4155 SWEETMAN RD
Mailing Address - Street 2:
Mailing Address - City:MARBURY
Mailing Address - State:MD
Mailing Address - Zip Code:20658-2116
Mailing Address - Country:US
Mailing Address - Phone:614-373-7455
Mailing Address - Fax:
Practice Address - Street 1:11720 BELTSVILLE DR STE 500A15
Practice Address - Street 2:
Practice Address - City:BELTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705-3166
Practice Address - Country:US
Practice Address - Phone:202-790-8903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-12
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician