Provider Demographics
NPI:1972088482
Name:EVANS, ANN METTEN
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:METTEN
Last Name:EVANS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 KEEPSAKE LN
Mailing Address - Street 2:
Mailing Address - City:CHADDS FORD
Mailing Address - State:PA
Mailing Address - Zip Code:19317-9702
Mailing Address - Country:US
Mailing Address - Phone:610-558-1829
Mailing Address - Fax:610-558-2390
Practice Address - Street 1:108 KEEPSAKE LN
Practice Address - Street 2:
Practice Address - City:CHADDS FORD
Practice Address - State:PA
Practice Address - Zip Code:19317-9702
Practice Address - Country:US
Practice Address - Phone:610-558-1829
Practice Address - Fax:610-558-2390
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-01
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10241901041C0700X
MA1024190-SW-LICSW1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical