Provider Demographics
NPI:1114759073
Name:SWITZER, EVAN JAMES
Entity type:Individual
Prefix:
First Name:EVAN
Middle Name:JAMES
Last Name:SWITZER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:590 MAUREEN CIR
Mailing Address - Street 2:
Mailing Address - City:MAPLEVILLE
Mailing Address - State:RI
Mailing Address - Zip Code:02839-1136
Mailing Address - Country:US
Mailing Address - Phone:401-829-9787
Mailing Address - Fax:
Practice Address - Street 1:99 S MAIN ST STE 10
Practice Address - Street 2:
Practice Address - City:FALL RIVER
Practice Address - State:MA
Practice Address - Zip Code:02721-5349
Practice Address - Country:US
Practice Address - Phone:800-679-3609
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-19
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALABA1001068103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst