Provider Demographics
NPI:1528285418
Name:EVANS, VELMA ANN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:VELMA
Middle Name:ANN
Last Name:EVANS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:166 PERHAM ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:ME
Mailing Address - Zip Code:04938-1523
Mailing Address - Country:US
Mailing Address - Phone:207-491-7856
Mailing Address - Fax:207-250-4516
Practice Address - Street 1:124 MAIN ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:ME
Practice Address - Zip Code:04938-1857
Practice Address - Country:US
Practice Address - Phone:207-491-7856
Practice Address - Fax:207-250-4516
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2022-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC99751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME431554199Medicaid
MEEV-ME1841Medicare ID - Type Unspecified