Healthcare Provider Details

I. General information

NPI: 1063341576
Provider Name (Legal Business Name): EQV EVOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

389 W RIVER RD
AUGUSTA ME
04330-8144
US

IV. Provider business mailing address

14 CROSSING WAY STE 3 #1047
AUGUSTA ME
04330-6107
US

V. Phone/Fax

Practice location:
  • Phone: 207-200-6147
  • Fax: 207-200-3866
Mailing address:
  • Phone: 207-200-6147
  • Fax: 207-200-3866

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. KEVIN PACIFICO TAPP GONZAGA
Title or Position: PSYCHOLOGIST
Credential: PHD
Phone: 207-200-6147