Provider Demographics
NPI:1952155608
Name:GARCON, EVELANDE
Entity Type:Individual
Prefix:
First Name:EVELANDE
Middle Name:
Last Name:GARCON
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 1:56 WILLOW ST APT 7
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02141-1345
Mailing Address - Country:US
Mailing Address - Phone:857-891-0625
Mailing Address - Fax:
Practice Address - Street 1:56 WILLOW ST APT 7
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02141-1345
Practice Address - Country:US
Practice Address - Phone:857-891-0625
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-17
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician