Provider Demographics
NPI:1821814724
Name:EVOLVING LLC
Entity type:Organization
Organization Name:EVOLVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CARLA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:203-710-4265
Mailing Address - Street 1:141 FORGE DR
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-3246
Mailing Address - Country:US
Mailing Address - Phone:203-710-4265
Mailing Address - Fax:
Practice Address - Street 1:146 ELM ST
Practice Address - Street 2:
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-2869
Practice Address - Country:US
Practice Address - Phone:203-439-7545
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:EVOLVE BEHAVIORAL INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-11-25
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty