Provider Demographics
NPI:1467067728
Name:EVANS, MEGAN (LMSW)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 W 74TH ST APT D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-2430
Mailing Address - Country:US
Mailing Address - Phone:518-637-3941
Mailing Address - Fax:
Practice Address - Street 1:98120 QUEENS BLVD STE 1C
Practice Address - Street 2:
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-4414
Practice Address - Country:US
Practice Address - Phone:518-637-3941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-14
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY105574-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker