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General NPI Number Information
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NPI Number | 1336214477
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Entity Type | Individual
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Provider Name | EVAN B. DRAKE PH.D.
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Gender | Male
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Dates
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Enumeration Date | 11/22/2006
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Last Update Date | 03/19/2019
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Provider Practice Location Address
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Address Line | 28 THORNDAL CIR STE 3
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City | DARIEN
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State | CT
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Zip | 06820-5429
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Country | US
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Telephone | 203-309-2707
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Fax | 877-951-2288
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Provider Business Mailing Address
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Address Line | 23 NICKERSON LN
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City | DARIEN
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State | CT
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Zip | 06820-5720
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Country | US
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Telephone | 203-309-2707
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Fax | 877-951-2288
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 003265
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License Number State | CT
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