Provider Demographics
NPI:1306623624
Name:EVELYN, HOPE MICHELE (MSW, LICSW)
Entity type:Individual
Prefix:
First Name:HOPE
Middle Name:MICHELE
Last Name:EVELYN
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 RIVERBOAT VILLAGE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH HADLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01075-1348
Mailing Address - Country:US
Mailing Address - Phone:860-913-8651
Mailing Address - Fax:
Practice Address - Street 1:148 EASTERN BLVD STE 200
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-4321
Practice Address - Country:US
Practice Address - Phone:860-815-8991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-11
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1268821041C0700X
CT0137371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical