Provider Demographics
NPI:1518575786
Name:EAVAN MILES-MASON, PHD LLC
Entity type:Organization
Organization Name:EAVAN MILES-MASON, PHD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC NEUROPSYCHOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:EAVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DURWIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-493-2848
Mailing Address - Street 1:747 MAIN ST # 228
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-3302
Mailing Address - Country:US
Mailing Address - Phone:978-493-2848
Mailing Address - Fax:
Practice Address - Street 1:747 MAIN ST # 228
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-3302
Practice Address - Country:US
Practice Address - Phone:978-493-2848
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-14
Last Update Date:2022-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Single Specialty