Healthcare Provider Details

I. General information

NPI: 1649778226
Provider Name (Legal Business Name): BENJAMIN EVARE PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2018
Last Update Date: 05/30/2026
Certification Date: 05/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 LAKE DR
BOULDER CREEK CA
95006-9281
US

IV. Provider business mailing address

185 LAKE DR
BOULDER CREEK CA
95006-9281
US

V. Phone/Fax

Practice location:
  • Phone: 650-223-5389
  • Fax:
Mailing address:
  • Phone: 650-223-5389
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number29833
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: