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NPI Code Detail

MEDICARE: GENEVRA B EVANS LCSW

MEDICARE: GENEVRA B EVANS LCSW
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
11041C0700XClinical Social WorkerLC6737ME
21041C0700XClinical Social Worker258271KY

General Provider Information

NPI Number : 1639237860
Entity Type Code : Individual
Provider Name (Legal Business Name) : GENEVRA B EVANS LCSW
Provider Business Mailing Address
First Line : 152 COUILLARD RD
Second Line :
City : PALERMO
State : ME
Zip : 04354-7666
Country : US
Telephone Number : 207-993-2741
Fax Number :
Provider Business Practice Location Address
First Line : 828 LANE ALLEN RD STE 219
Second Line :
City : LEXINGTON
State : KY
Zip : 40504-3659
Country : US
Telephone Number : 260-483-9081
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/04/2006
Last Update Date : 08/08/2023

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