Provider Demographics
NPI:1689962771
Name:KNIGHT, EVAN DANA SR
Entity Type:Individual
Prefix:MR
First Name:EVAN
Middle Name:DANA
Last Name:KNIGHT
Suffix:SR
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 1:116 RIVER ST
Mailing Address - Street 2:25
Mailing Address - City:MATTAPAN
Mailing Address - State:MA
Mailing Address - Zip Code:02126-2973
Mailing Address - Country:US
Mailing Address - Phone:617-749-5500
Mailing Address - Fax:
Practice Address - Street 1:116 RIVER ST
Practice Address - Street 2:25
Practice Address - City:MATTAPAN
Practice Address - State:MA
Practice Address - Zip Code:02126-2973
Practice Address - Country:US
Practice Address - Phone:617-749-5500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-11
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health