Provider Demographics
NPI:1306909239
Name:EVANS, URSULA NICOLE (MS)
Entity type:Individual
Prefix:MS
First Name:URSULA
Middle Name:NICOLE
Last Name:EVANS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:605 LOUISIANA AVE
Mailing Address - Street 2:APT. # 12G
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11239-1517
Mailing Address - Country:US
Mailing Address - Phone:251-623-9935
Mailing Address - Fax:
Practice Address - Street 1:1979 MARCUS AVE
Practice Address - Street 2:SIUTE 204
Practice Address - City:NEW HYDE PARK
Practice Address - State:NY
Practice Address - Zip Code:11042-1002
Practice Address - Country:US
Practice Address - Phone:516-327-4681
Practice Address - Fax:516-327-4684
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling