Provider Demographics
NPI:1558609537
Name:PETIT, EVENS
Entity Type:Individual
Prefix:
First Name:EVENS
Middle Name:
Last Name:PETIT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4995 SABLE PINE CIR APT D2
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33417-3117
Mailing Address - Country:US
Mailing Address - Phone:561-506-7704
Mailing Address - Fax:
Practice Address - Street 1:4995 SABLE PINE CIR APT D2
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33417-3117
Practice Address - Country:US
Practice Address - Phone:561-506-7704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-25
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker