Provider Demographics
NPI:1639510712
Name:MOWERY, EVAN
Entity Type:Individual
Prefix:MR
First Name:EVAN
Middle Name:
Last Name:MOWERY
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 1:690 MAIN ST
Mailing Address - Street 2:APT. #1
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02148-3751
Mailing Address - Country:US
Mailing Address - Phone:508-414-9381
Mailing Address - Fax:
Practice Address - Street 1:690 MAIN ST
Practice Address - Street 2:APT. #1
Practice Address - City:MALDEN
Practice Address - State:MA
Practice Address - Zip Code:02148-3751
Practice Address - Country:US
Practice Address - Phone:508-414-9381
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-17
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor