Provider Demographics
NPI:1851623193
Name:EVANS, JAMELYNN (LICSW)
Entity Type:Individual
Prefix:MS
First Name:JAMELYNN
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:485 NANTASKET AVE
Mailing Address - Street 2:
Mailing Address - City:HULL
Mailing Address - State:MA
Mailing Address - Zip Code:02045-2556
Mailing Address - Country:US
Mailing Address - Phone:781-925-2423
Mailing Address - Fax:781-925-2650
Practice Address - Street 1:485 NANTASKET AVE
Practice Address - Street 2:
Practice Address - City:HULL
Practice Address - State:MA
Practice Address - Zip Code:02045-2556
Practice Address - Country:US
Practice Address - Phone:781-925-2423
Practice Address - Fax:781-925-2650
Is Sole Proprietor?:No
Enumeration Date:2010-02-11
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA216070101YA0400X
MA1174571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)