Provider Demographics
NPI:1811650682
Name:EVANS, KRISTINA KARIN
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:KARIN
Last Name:EVANS
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 1:58 HIMROD ST APT 1L
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11221-3450
Mailing Address - Country:US
Mailing Address - Phone:631-339-2395
Mailing Address - Fax:
Practice Address - Street 1:58 HIMROD ST APT 1L
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11221-3450
Practice Address - Country:US
Practice Address - Phone:631-339-2395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-19
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst