Provider Demographics
NPI:1720777444
Name:EVELYN, JARED
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:
Last Name:EVELYN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 THOMAS DR
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01701-8810
Mailing Address - Country:US
Mailing Address - Phone:508-654-6453
Mailing Address - Fax:
Practice Address - Street 1:9 THOMAS DR
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01701-8810
Practice Address - Country:US
Practice Address - Phone:508-654-6453
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-08
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling