Provider Demographics
NPI:1417648668
Name:EVANS, SERGEI BERGES (MSW, MHC)
Entity Type:Individual
Prefix:
First Name:SERGEI
Middle Name:BERGES
Last Name:EVANS
Suffix:
Gender:M
Credentials:MSW, MHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 ELECTRONICS AVE.
Mailing Address - Street 2:UNIT 40
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923
Mailing Address - Country:US
Mailing Address - Phone:978-350-5161
Mailing Address - Fax:
Practice Address - Street 1:1 CLARKS HL
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-8172
Practice Address - Country:US
Practice Address - Phone:914-733-2820
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-18
Last Update Date:2024-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No225XM0800XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistMental Health