Provider Demographics
NPI:1992532873
Name:CONNORS, EVAN DANIEL
Entity type:Individual
Prefix:
First Name:EVAN
Middle Name:DANIEL
Last Name:CONNORS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:789 W YAMATO RD APT 330
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-4521
Mailing Address - Country:US
Mailing Address - Phone:203-564-3235
Mailing Address - Fax:
Practice Address - Street 1:789 W YAMATO RD APT 330
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-4521
Practice Address - Country:US
Practice Address - Phone:203-564-3235
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1143223106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician