Provider Demographics
NPI:1497995476
Name:BURROUGHS, EVELYN (CASAC)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:
Last Name:BURROUGHS
Suffix:
Gender:F
Credentials:CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215-1217 STRATFORD AVENUE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10472
Mailing Address - Country:US
Mailing Address - Phone:718-328-2605
Mailing Address - Fax:718-328-2609
Practice Address - Street 1:1215 STRATFORD AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10472-2501
Practice Address - Country:US
Practice Address - Phone:718-328-2605
Practice Address - Fax:718-328-2609
Is Sole Proprietor?:No
Enumeration Date:2009-03-03
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY13118101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)