Provider Demographics
NPI:1720472129
Name:MCEVOY, LAURA
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:
Last Name:MCEVOY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 CONANT RD
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02171-1805
Mailing Address - Country:US
Mailing Address - Phone:617-448-3561
Mailing Address - Fax:781-817-6427
Practice Address - Street 1:400 WASHINGTON ST
Practice Address - Street 2:SUITE 106
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-4729
Practice Address - Country:US
Practice Address - Phone:781-817-6386
Practice Address - Fax:781-817-6427
Is Sole Proprietor?:No
Enumeration Date:2015-03-24
Last Update Date:2015-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor