Provider Demographics
NPI:1326674516
Name:THALL, EVA MARIA
Entity Type:Individual
Prefix:MRS
First Name:EVA
Middle Name:MARIA
Last Name:THALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1910 82ND AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32966-6991
Mailing Address - Country:US
Mailing Address - Phone:772-492-9841
Mailing Address - Fax:
Practice Address - Street 1:1910 82ND AVE STE 102
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32966-6991
Practice Address - Country:US
Practice Address - Phone:772-492-9841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-19
Last Update Date:2020-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker