Healthcare Provider Details

I. General information

NPI: 1548158777
Provider Name (Legal Business Name): EVAN JOSEPH MYERS PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2025
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 MASSACHUSETTS AVE
BOSTON MA
02118-2605
US

IV. Provider business mailing address

801 MASSACHUSETTS AVE
BOSTON MA
02118-2605
US

V. Phone/Fax

Practice location:
  • Phone: 339-987-6050
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY10002169
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: