Provider Demographics
NPI:1912426594
Name:EVANS, CURTIS (CASAC-G/CPP-G)
Entity Type:Individual
Prefix:
First Name:CURTIS
Middle Name:
Last Name:EVANS
Suffix:
Gender:M
Credentials:CASAC-G/CPP-G
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:YONKERS
Mailing Address - State:NY
Mailing Address - Zip Code:10701-1712
Mailing Address - Country:US
Mailing Address - Phone:347-210-2943
Mailing Address - Fax:718-658-5913
Practice Address - Street 1:17520 HILLSIDE AVE STE 2
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-5732
Practice Address - Country:US
Practice Address - Phone:347-210-2943
Practice Address - Fax:718-558-7230
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-14
Last Update Date:2017-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NY706405300000X
NY10181101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No405300000XOther Service ProvidersPrevention Professional