Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist |
NPI | 1093227928 |
---|---|
Provider Name | Dr. Spencer C. Evans |
First Address | Cambridge, MA 02138-4392 |
Second Address | Cambridge, MA 02139-1047 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2017 |
Last Update Date | 01/11/2017 |