Provider Demographics
NPI:1497588289
Name:MCEVOY, JUSTIN JOSEPH (APRN PMHNP-BC)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:JOSEPH
Last Name:MCEVOY
Suffix:
Gender:M
Credentials:APRN PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:928 HAWKINS AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE GROVE
Mailing Address - State:NY
Mailing Address - Zip Code:11755-1642
Mailing Address - Country:US
Mailing Address - Phone:631-905-6774
Mailing Address - Fax:
Practice Address - Street 1:928 HAWKINS AVE
Practice Address - Street 2:
Practice Address - City:LAKE GROVE
Practice Address - State:NY
Practice Address - Zip Code:11755-1642
Practice Address - Country:US
Practice Address - Phone:631-905-6774
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-26
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY406085363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health