Provider Demographics
NPI:1922684257
Name:OPPENHEIMER, EVAN MATTHEW (LCMHC)
Entity Type:Individual
Prefix:
First Name:EVAN
Middle Name:MATTHEW
Last Name:OPPENHEIMER
Suffix:
Gender:M
Credentials:LCMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 E WARREN RD
Mailing Address - Street 2:
Mailing Address - City:WAITSFIELD
Mailing Address - State:VT
Mailing Address - Zip Code:05673-7310
Mailing Address - Country:US
Mailing Address - Phone:516-359-0292
Mailing Address - Fax:
Practice Address - Street 1:5354 MAIN ST
Practice Address - Street 2:
Practice Address - City:WAITSFIELD
Practice Address - State:VT
Practice Address - Zip Code:05673-6003
Practice Address - Country:US
Practice Address - Phone:802-583-1144
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-18
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health