Provider Demographics
NPI:1326530197
Name:TSOULES, EVANS WILLIAM (EDD)
Entity Type:Individual
Prefix:
First Name:EVANS
Middle Name:WILLIAM
Last Name:TSOULES
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 OLD CRAIGVILLE RD
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02632-3734
Mailing Address - Country:US
Mailing Address - Phone:508-864-1282
Mailing Address - Fax:
Practice Address - Street 1:25 BURNCOAT ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-1800
Practice Address - Country:US
Practice Address - Phone:508-864-1282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-06
Last Update Date:2018-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1522103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist