Provider Demographics
NPI:1669503140
Name:ANDERSON, EVA K (PHD)
Entity Type:Individual
Prefix:DR
First Name:EVA
Middle Name:K
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:EVA
Other - Middle Name:K
Other - Last Name:WOOLFOLK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:540 RIVERSIDE DR
Mailing Address - Street 2:STE 2
Mailing Address - City:SALISBURY
Mailing Address - State:MA
Mailing Address - Zip Code:21801
Mailing Address - Country:US
Mailing Address - Phone:410-548-7883
Mailing Address - Fax:410-548-2831
Practice Address - Street 1:540 RIVERSIDE DR
Practice Address - Street 2:STE 2
Practice Address - City:SALISBURY
Practice Address - State:MA
Practice Address - Zip Code:21801
Practice Address - Country:US
Practice Address - Phone:410-548-7883
Practice Address - Fax:410-548-2831
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD00891103T00000X, 103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG007Medicare ID - Type Unspecified