Provider Demographics
NPI:1831507425
Name:EVANS, BRIGET ANTOINETTE (LICSW)
Entity type:Individual
Prefix:MRS
First Name:BRIGET
Middle Name:ANTOINETTE
Last Name:EVANS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 CHERYL LN
Mailing Address - Street 2:
Mailing Address - City:HYDE PARK
Mailing Address - State:MA
Mailing Address - Zip Code:02136-1219
Mailing Address - Country:US
Mailing Address - Phone:617-771-0275
Mailing Address - Fax:
Practice Address - Street 1:6 CHERYL LN
Practice Address - Street 2:
Practice Address - City:HYDE PARK
Practice Address - State:MA
Practice Address - Zip Code:02136-1219
Practice Address - Country:US
Practice Address - Phone:617-771-0275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-26
Last Update Date:2015-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1131361041C0700X, 1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool