NPI Code Details Logo

NPI 1508375312

NPI 1508375312 : EMILEA EVANS : JIM THORPE, PA

=====================================================
General NPI Number Information
=====================================================
    NPI Number           |    1508375312
-----------------------------------------------------
    Entity Type          |    Individual 
-----------------------------------------------------
    Provider Name        |    EMILEA EVANS
-----------------------------------------------------
    Gender               |    Female 
-----------------------------------------------------

=====================================================
Dates
=====================================================
    Enumeration Date     |    09/25/2017
-----------------------------------------------------
    Last Update Date     |    08/28/2025
-----------------------------------------------------

=====================================================
Provider Practice Location Address
=====================================================
    Address Line         |    1026 BROADVIEW DR 
-----------------------------------------------------
    City                 |    JIM THORPE
-----------------------------------------------------
    State                |    PA
-----------------------------------------------------
    Zip                  |    18229-1577
-----------------------------------------------------
    Country              |    US
-----------------------------------------------------
    Telephone            |    610-972-8799
-----------------------------------------------------
    Fax                  |    
-----------------------------------------------------

=====================================================
Provider Business Mailing Address
=====================================================
    Address Line         |    1026 BROADVIEW DR 
-----------------------------------------------------
    City                 |    JIM THORPE
-----------------------------------------------------
    State                |    PA
-----------------------------------------------------
    Zip                  |    18229-1577
-----------------------------------------------------
    Country              |    US
-----------------------------------------------------
    Telephone            |    
-----------------------------------------------------
    Fax                  |    
-----------------------------------------------------

=====================================================
Authorized Official
=====================================================
    Title or Position    |    
-----------------------------------------------------
    Name                 |        
-----------------------------------------------------
    Credential           |    
-----------------------------------------------------
    Telephone            |    
-----------------------------------------------------

=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
    Taxonomy Code        |    104100000X
-----------------------------------------------------
    Taxonomy Name        |    Social Worker
-----------------------------------------------------
    License Number       |    
-----------------------------------------------------
    License Number State |    PA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
    Taxonomy Code        |    1041C0700X
-----------------------------------------------------
    Taxonomy Name        |    Clinical Social Worker
-----------------------------------------------------
    License Number       |    CW024756
-----------------------------------------------------
    License Number State |    PA
-----------------------------------------------------



                        

Copyright © 2007-2026 Data Labs Health. All rights reserved.