MEDICARE: EVENS STEPHEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1184128019
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EVENS STEPHEN

Provider Business Mailing Address
First Line	:	7124 COLONY CLUB DR APT 209
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33463-7823
Country	:	US
Telephone Number	:	561-945-2451
Fax Number	:

Provider Business Practice Location Address
First Line	:	7124 COLONY CLUB DR APT 209
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33463-7823
Country	:	US
Telephone Number	:	561-945-2451
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2018
Last Update Date	:	03/23/2018

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Directions to “ EVENS STEPHEN ” Practice Location

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