Provider Demographics
NPI:1356194492
Name:EVANS, ISABELLA (PSYD)
Entity type:Individual
Prefix:
First Name:ISABELLA
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:QUARRYVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17566-1268
Mailing Address - Country:US
Mailing Address - Phone:717-806-5050
Mailing Address - Fax:717-806-5179
Practice Address - Street 1:215 E STATE ST
Practice Address - Street 2:
Practice Address - City:QUARRYVILLE
Practice Address - State:PA
Practice Address - Zip Code:17566-1268
Practice Address - Country:US
Practice Address - Phone:717-806-5050
Practice Address - Fax:717-806-5179
Is Sole Proprietor?:No
Enumeration Date:2024-04-09
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS019460103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral