Provider Demographics
NPI:1366589046
Name:EVANS, ROBERT A (PHD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:A
Last Name:EVANS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:670 2ND ST N
Mailing Address - Street 2:SUITE D
Mailing Address - City:SAFETY HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34695-3563
Mailing Address - Country:US
Mailing Address - Phone:727-669-5707
Mailing Address - Fax:727-669-5733
Practice Address - Street 1:670 2ND ST N
Practice Address - Street 2:SUITE D
Practice Address - City:SAFETY HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34695-3563
Practice Address - Country:US
Practice Address - Phone:727-669-5707
Practice Address - Fax:727-669-5733
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSS361103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool