Provider Demographics
NPI:1205546843
Name:ORMOND, EVAN (LCSW)
Entity type:Individual
Prefix:
First Name:EVAN
Middle Name:
Last Name:ORMOND
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 HICKORY WAY
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06907-1305
Mailing Address - Country:US
Mailing Address - Phone:203-667-6856
Mailing Address - Fax:
Practice Address - Street 1:208 VALLEY RD
Practice Address - Street 2:
Practice Address - City:NEW CANAAN
Practice Address - State:CT
Practice Address - Zip Code:06840-3812
Practice Address - Country:US
Practice Address - Phone:203-667-6856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT123481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical