Provider Demographics
NPI:1487676698
Name:EVERT, CONSTANCE (PHD)
Entity Type:Individual
Prefix:DR
First Name:CONSTANCE
Middle Name:
Last Name:EVERT
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 1:100 S. BROAD STREET
Mailing Address - Street 2:SUITE 1521
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19110-1026
Mailing Address - Country:US
Mailing Address - Phone:267-972-5442
Mailing Address - Fax:
Practice Address - Street 1:100 S. BROAD STREET
Practice Address - Street 2:SUITE 1521
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19110-1026
Practice Address - Country:US
Practice Address - Phone:267-972-5442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2016-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS008057L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA248073000OtherMAGELLAN PROVIDER NUMBER
PA054495Medicare ID - Type Unspecified