Provider Demographics
NPI:1770646424
Name:LLEWELLYN, EVELYN LINDA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:EVELYN
Middle Name:LINDA
Last Name:LLEWELLYN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 MUSKET LN
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:CT
Mailing Address - Zip Code:06820-4906
Mailing Address - Country:US
Mailing Address - Phone:203-912-5719
Mailing Address - Fax:203-698-1548
Practice Address - Street 1:6 MUSKET LN
Practice Address - Street 2:
Practice Address - City:DARIEN
Practice Address - State:CT
Practice Address - Zip Code:06820-4906
Practice Address - Country:US
Practice Address - Phone:203-912-5719
Practice Address - Fax:203-698-1548
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-17
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009378-1103T00000X
CT3416103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY009378-1OtherLICENSE NUMBER
NY01506289Medicaid
NY02104396Medicaid
NY02104396Medicaid
NY009378-1OtherLICENSE NUMBER