Healthcare Provider Details

I. General information

NPI: 1518575786
Provider Name (Legal Business Name): EAVAN MILES-MASON, PHD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2020
Last Update Date: 10/04/2022
Certification Date: 10/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

747 MAIN ST # 228
CONCORD MA
01742-3302
US

IV. Provider business mailing address

747 MAIN ST # 228
CONCORD MA
01742-3302
US

V. Phone/Fax

Practice location:
  • Phone: 978-493-2848
  • Fax:
Mailing address:
  • Phone: 978-493-2848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. EAVAN DURWIN
Title or Position: PEDIATRIC NEUROPSYCHOGIST
Credential:
Phone: 978-493-2848