Provider Demographics
NPI:1134273022
Name:EVANS, ROBERT VAN SCOTT (LCSW-C)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:VAN SCOTT
Last Name:EVANS
Suffix:
Gender:M
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 GLENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21014-5533
Mailing Address - Country:US
Mailing Address - Phone:410-836-0989
Mailing Address - Fax:
Practice Address - Street 1:200 BOOTH ST
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-5657
Practice Address - Country:US
Practice Address - Phone:410-996-5197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD146671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical