Provider Demographics
NPI:1801265707
Name:EVANOVICH, JOSEY ALAINE (LCSW)
Entity type:Individual
Prefix:
First Name:JOSEY
Middle Name:ALAINE
Last Name:EVANOVICH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JOSEY
Other - Middle Name:ALAINE
Other - Last Name:KELLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:359 BALLSTON AVE
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-4723
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:125 MIDDLETOWN RD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:NY
Practice Address - Zip Code:12188-1516
Practice Address - Country:US
Practice Address - Phone:518-237-0800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-21
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY095877-1104100000X
NY088216-011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker