Provider Demographics
NPI:1407404684
Name:EVARTS, SIOBHAN O'LEARY (PHD)
Entity Type:Individual
Prefix:DR
First Name:SIOBHAN
Middle Name:O'LEARY
Last Name:EVARTS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 LONGMEADOW RD
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-2536
Mailing Address - Country:US
Mailing Address - Phone:917-863-9140
Mailing Address - Fax:
Practice Address - Street 1:1275 POST RD STE A18
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-6060
Practice Address - Country:US
Practice Address - Phone:917-863-9140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-30
Last Update Date:2019-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018513103TC0700X
CT003046103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical