Provider Demographics
NPI:1134826738
Name:THOMAS, EVELYN MARIAH (LMSW)
Entity type:Individual
Prefix:MS
First Name:EVELYN
Middle Name:MARIAH
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-4516
Mailing Address - Country:US
Mailing Address - Phone:631-427-3700
Mailing Address - Fax:
Practice Address - Street 1:90 ADAMS AVE
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-3631
Practice Address - Country:US
Practice Address - Phone:631-427-3700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-14
Last Update Date:2025-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY118537-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker