Basic Information
| Provider Information | |||||||||
| NPI: | 1881264521 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | EVANS | ||||||||
| FirstName: | LOGAN | ||||||||
| MiddleName: | DEAN | ||||||||
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| Credential: | LMSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 282 E 35TH ST APT 6H | ||||||||
| Address2: | |||||||||
| City: | BROOKLYN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 112033932 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9293757988 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2090 ADAM CLAYTON POWELL JR BLVD FL 4 | ||||||||
| Address2: | |||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100274941 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2125536708 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2021 | ||||||||
| LastUpdateDate: | 06/25/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 108469 | NY | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.