Provider Demographics
NPI:1750163242
Name:AUGUSTE, EVAN
Entity type:Individual
Prefix:
First Name:EVAN
Middle Name:
Last Name:AUGUSTE
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 1:100 MORRISSEY BLVD
Mailing Address - Street 2:MCCORMACK HALL, DEPARTMENT OF PSYCHOLOGY
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02125
Mailing Address - Country:US
Mailing Address - Phone:516-423-6338
Mailing Address - Fax:
Practice Address - Street 1:100 MORRISSEY BLVD
Practice Address - Street 2:MCCORMACK HALL, DEPARTMENT OF PSYCHOLOGY
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02125
Practice Address - Country:US
Practice Address - Phone:516-423-6338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-18
Last Update Date:2023-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor