Provider Demographics
NPI:1962823179
Name:EVANS, JEREMEA ALLANAH (LMSW)
Entity Type:Individual
Prefix:MISS
First Name:JEREMEA
Middle Name:ALLANAH
Last Name:EVANS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:J. ALLANAH
Other - Middle Name:
Other - Last Name:EVANS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW
Mailing Address - Street 1:2186 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10037-2704
Mailing Address - Country:US
Mailing Address - Phone:646-584-7105
Mailing Address - Fax:
Practice Address - Street 1:27 CHRISTOPHER ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10014-3518
Practice Address - Country:US
Practice Address - Phone:646-584-7105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-16
Last Update Date:2013-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY088571-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical