MEDICARE: DR. CONSTANCE EVERT PH.D.

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	103TC0700X	Clinical Psychologist	PS008057L	PA

General Provider Information

NPI Number	:	1487676698
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CONSTANCE EVERT PH.D.

Provider Business Mailing Address
First Line	:	100 S. BROAD STREET
Second Line	:	SUITE 1521
City	:	PHILADELPHIA
State	:	PA
Zip	:	19110-1026
Country	:	US
Telephone Number	:	267-972-5442
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 S. BROAD STREET
Second Line	:	SUITE 1521
City	:	PHILADELPHIA
State	:	PA
Zip	:	19110-1026
Country	:	US
Telephone Number	:	267-972-5442
Fax Number	:

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

Provider Enumeration Date	:	07/24/2006
Last Update Date	:	09/10/2016

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