| Evolve Behavioral Inc. | |
|
146 Elm St Cheshire CT 06410-2808 | |
| (203) 439-7545 | |
| Not Available |
| Full Name | Evolve Behavioral Inc. |
|---|---|
| Speciality | Social Worker |
| Location | 146 Elm St, Cheshire, Connecticut |
| Authorized Official Name and Position | Carla Martin (PRESIDENT) |
| Authorized Official Contact | 2034397545 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Evolve Behavioral Inc. 141 Forge Dr Avon CT 06001-3246 Ph: (203) 710-4265 | Evolve Behavioral Inc. 146 Elm St Cheshire CT 06410-2808 Ph: (203) 439-7545 |
| NPI Number | 1639677149 |
|---|---|
| Provider Enumeration Date | 01/30/2018 |
| Last Update Date | 01/30/2018 |
| Medicare PECOS PAC ID | 2466716329 |
|---|---|
| Medicare Enrollment ID | O20180502000078 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639677149 | NPI | - | NPPES |
| 008030935 | Medicaid | CT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 0056 (Connecticut) | Primary |
| Provider Name | Carla L Martin |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1669685145 PECOS PAC ID: 5890743991 Enrollment ID: I20050105000698 |
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