Provider Demographics
NPI:1457436404
Name:MARGETSON, EVAN KEITH (LICSW)
Entity Type:Individual
Prefix:
First Name:EVAN
Middle Name:KEITH
Last Name:MARGETSON
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 WARDWELL AVE
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01902-1924
Mailing Address - Country:US
Mailing Address - Phone:781-599-5571
Mailing Address - Fax:
Practice Address - Street 1:100 CUMMINGS CENTER SUITE 217C
Practice Address - Street 2:THE BEVERLY CENTER, PC
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915
Practice Address - Country:US
Practice Address - Phone:978-922-6613
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA110508101YA0400X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1890891Medicaid
MAP08000OtherBLUE CROSS/BLUE SHIELD
MA110508OtherTUFTS
MA1890891Medicaid