Provider Demographics
NPI:1609598234
Name:KING, EVELYN (LICSW)
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:
Last Name:KING
Suffix:
Gender:
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:177 HUNTINGTON AVE FL 14
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-3134
Mailing Address - Country:US
Mailing Address - Phone:888-572-0795
Mailing Address - Fax:
Practice Address - Street 1:177 HUNTINGTON AVE FL 14
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-3134
Practice Address - Country:US
Practice Address - Phone:888-572-0795
Practice Address - Fax:978-496-8771
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-12
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2282891041C0700X
MA11212171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical