Provider Demographics
NPI:1396248886
Name:WHITTEN, EVANS (LICSW)
Entity type:Individual
Prefix:
First Name:EVANS
Middle Name:
Last Name:WHITTEN
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 1:3 FERRY ST STE 2
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01835-7441
Mailing Address - Country:US
Mailing Address - Phone:978-469-8800
Mailing Address - Fax:
Practice Address - Street 1:3 FERRY ST STE 2
Practice Address - Street 2:
Practice Address - City:BRADFORD
Practice Address - State:MA
Practice Address - Zip Code:01835-7441
Practice Address - Country:US
Practice Address - Phone:603-327-7124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-12
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10285861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty