=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902998131
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LINDA A. EVANS, PH.D., PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/28/2006
-----------------------------------------------------
Last Update Date | 09/29/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 101 N OCEAN DR SUITE 212
-----------------------------------------------------
City | HOLLYWOOD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33019-1728
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-699-9660
-----------------------------------------------------
Fax | 964-921-9126
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 101 N OCEAN DR SUITE 212
-----------------------------------------------------
City | HOLLYWOOD
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33019-1728
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-699-9660
-----------------------------------------------------
Fax | 964-921-9126
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LICENSED PSYCHOLOGIST/OWNER
-----------------------------------------------------
Name | DR. LINDA ANN EVANS
-----------------------------------------------------
Credential | PH.D.
-----------------------------------------------------
Telephone | 954-699-9660
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------