Provider Demographics
NPI:1174132237
Name:MAMMEN, EVELYN
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:
Last Name:MAMMEN
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 1:1126 ORIOLE DR
Mailing Address - Street 2:
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-4410
Mailing Address - Country:US
Mailing Address - Phone:631-487-0897
Mailing Address - Fax:
Practice Address - Street 1:2514 N BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19132-4013
Practice Address - Country:US
Practice Address - Phone:215-599-2845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-24
Last Update Date:2020-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health