MEDICARE: EVENS PETIT

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	104100000X	Social Worker

General Provider Information

NPI Number	:	1558609537
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EVENS PETIT

Provider Business Mailing Address
First Line	:	4995 SABLE PINE CIR APT D2
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33417-3117
Country	:	US
Telephone Number	:	561-506-7704
Fax Number	:

Provider Business Practice Location Address
First Line	:	4995 SABLE PINE CIR APT D2
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33417-3117
Country	:	US
Telephone Number	:	561-506-7704
Fax Number	:

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

Provider Enumeration Date	:	01/25/2013
Last Update Date	:	01/25/2013

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Directions to “ EVENS PETIT ” Practice Location

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