Provider Demographics
NPI:1780698944
Name:EVANS, LINDA ANN (PHD)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:ANN
Last Name:EVANS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 S SURF RD
Mailing Address - Street 2:APT. 305
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33019-2008
Mailing Address - Country:US
Mailing Address - Phone:954-699-9660
Mailing Address - Fax:954-921-9126
Practice Address - Street 1:101 N OCEAN DR
Practice Address - Street 2:SUITE 212
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33019-1728
Practice Address - Country:US
Practice Address - Phone:954-699-9660
Practice Address - Fax:954-921-9126
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6477103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
54767Medicare ID - Type Unspecified