Provider Demographics
NPI:1346565132
Name:ROBBENNOLT-JONES, EVELYN (LICSW)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:
Last Name:ROBBENNOLT-JONES
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:173 MIDDLE ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:NH
Mailing Address - Zip Code:03584-3508
Mailing Address - Country:US
Mailing Address - Phone:603-788-5029
Mailing Address - Fax:603-788-5607
Practice Address - Street 1:173 MIDDLE ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:NH
Practice Address - Zip Code:03584-3508
Practice Address - Country:US
Practice Address - Phone:603-788-5075
Practice Address - Fax:603-788-5285
Is Sole Proprietor?:No
Enumeration Date:2010-04-05
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH18121041C0700X
NY0535331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3099309Medicaid
VT1024196Medicaid