MEDICARE: HANNA EVANGELISTO MA, LBA, BCBA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	4157	NC

General Provider Information

NPI Number	:	1992481576
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HANNA EVANGELISTO MA, LBA, BCBA

Provider Business Mailing Address
First Line	:	2802 NEW BIRCH DR STE 100
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27610-7000
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2802 NEW BIRCH DR STE 100
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27610-7000
Country	:	US
Telephone Number	:	919-342-6047
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/27/2023
Last Update Date	:	04/24/2026

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