Provider Demographics
NPI:1902692460
Name:MCINTOSH, EVA
Entity type:Individual
Prefix:
First Name:EVA
Middle Name:
Last Name:MCINTOSH
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 OPUS DR
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19702-3013
Mailing Address - Country:US
Mailing Address - Phone:302-897-6852
Mailing Address - Fax:
Practice Address - Street 1:212 ARCHER ST STE A
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21014-3684
Practice Address - Country:US
Practice Address - Phone:443-729-0040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-18
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGP16344101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional