Provider Demographics
NPI:1649778226
Name:EVARE, BENJAMIN (PHD)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:EVARE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 VETERANS BLVD STE 204
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94063-1419
Mailing Address - Country:US
Mailing Address - Phone:650-223-5389
Mailing Address - Fax:650-679-8052
Practice Address - Street 1:617 VETERANS BLVD STE 204
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-1419
Practice Address - Country:US
Practice Address - Phone:650-223-5389
Practice Address - Fax:650-679-8052
Is Sole Proprietor?:No
Enumeration Date:2018-01-29
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29833103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical