Provider Demographics
NPI:1386876779
Name:EVERDS, MARK (LICSW)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:EVERDS
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 WALDO AVE # 1R
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02143-4319
Mailing Address - Country:US
Mailing Address - Phone:617-462-5479
Mailing Address - Fax:
Practice Address - Street 1:97 HOLMES STREET, 2ND FLOOR
Practice Address - Street 2:
Practice Address - City:NORTH QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02171
Practice Address - Country:US
Practice Address - Phone:617-462-5479
Practice Address - Fax:617-770-1174
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-18
Last Update Date:2014-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA114547101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health