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General NPI Number Information
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NPI Number | 1295533842
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Entity Type | Organization
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Legal Business Name | EVOLVE THERAPY PLLC
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Dates
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Enumeration Date | 03/07/2025
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Last Update Date | 03/22/2025
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Provider Practice Location Address
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Address Line | 102 COLLINS AVE
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City | SAYVILLE
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State | NY
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Zip | 11782-3102
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Country | US
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Telephone | 631-338-8315
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Fax |
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Provider Business Mailing Address
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Address Line | 102 COLLINS AVE
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City | SAYVILLE
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State | NY
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Zip | 11782-3102
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Country | US
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Telephone | 631-319-0558
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Fax |
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Authorized Official
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Title or Position | FOUNDER/OWNER
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Name | MRS. MICHELE GERMER
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Credential | LCSW
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Telephone | 631-338-8315
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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