Provider Demographics
NPI:1972487213
Name:EVANS, MADDOX DARIO (MA)
Entity type:Individual
Prefix:MR
First Name:MADDOX
Middle Name:DARIO
Last Name:EVANS
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:139 NORMAL AVE APT E11
Mailing Address - Street 2:
Mailing Address - City:KUTZTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19530-1754
Mailing Address - Country:US
Mailing Address - Phone:512-574-0933
Mailing Address - Fax:
Practice Address - Street 1:4905 W TILGHMAN ST STE 240
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-9133
Practice Address - Country:US
Practice Address - Phone:610-880-8592
Practice Address - Fax:484-727-8178
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-31
Last Update Date:2025-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAPC001527101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional