Provider Demographics
NPI:1396934543
Name:OUDJEHANE, EVELYN (LCSW)
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:
Last Name:OUDJEHANE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9231 57TH AVE
Mailing Address - Street 2:STE L-B
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-5024
Mailing Address - Country:US
Mailing Address - Phone:347-639-0024
Mailing Address - Fax:
Practice Address - Street 1:9231 57TH AVE
Practice Address - Street 2:STE L-B
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-5024
Practice Address - Country:US
Practice Address - Phone:347-639-0024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-23
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY070712-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical