Provider Demographics
NPI:1821865445
Name:GAVILANES, EVELIN MICHELLE
Entity Type:Individual
Prefix:
First Name:EVELIN
Middle Name:MICHELLE
Last Name:GAVILANES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15615 71ST AVE APT 1D
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11367-2207
Mailing Address - Country:US
Mailing Address - Phone:917-349-1524
Mailing Address - Fax:
Practice Address - Street 1:15615 71ST AVE APT 1D
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11367-2207
Practice Address - Country:US
Practice Address - Phone:917-349-1524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health