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General NPI Number Information
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NPI Number | 1447656897
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Entity Type | Individual
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Provider Name | WILLIAM EVANS III LCSW, PH.D.
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Gender | Male
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Dates
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Enumeration Date | 11/12/2014
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Last Update Date | 11/12/2014
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Provider Practice Location Address
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Address Line | 119 W 57TH ST SUITE 1006
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City | NEW YORK
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State | NY
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Zip | 10019-2303
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Country | US
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Telephone | 646-266-1978
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Fax |
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Provider Business Mailing Address
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Address Line | 149 FRANKLIN ST 5N
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City | NEW YORK
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State | NY
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Zip | 10013-2933
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Country | US
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Telephone | 646-266-1978
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Fax |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | R-051580
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License Number State | NY
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