Active NPI
Manuel Nazareno Evangelista, LCSW
- Social Worker
- Salt Lake, UT
National Provider Identifier
1467787515
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 6417919-3501
- Practice address
- 860 East 4500 South #302
Salt Lake, UT 84107 - Phone
- (801) 268-0333
- Fax
- (801) 268-3777
- NPI assigned
- Oct 7, 2009
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 6417919-3501 | UT | Primary |
Addresses
Primary practice location
860 East 4500 South #302
Salt Lake, UT 84107
Mailing address
860 East 4500 South #302
Salt Lake, UT 84107
Phone (801) 268-0333
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6417919-3501 | UT | MD | Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1254873600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1254873600000",
"number": "1467787515",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "860 EAST 4500 SOUTH #302",
"city": "SALT LAKE",
"state": "UT",
"postal_code": "84107",
"telephone_number": "801-268-0333",
"fax_number": "801-268-3777"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "860 EAST 4500 SOUTH #302",
"city": "SALT LAKE",
"state": "UT",
"postal_code": "84107",
"telephone_number": "801-268-0333",
"fax_number": "801-268-3777"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EVANGELISTA",
"first_name": "MANUEL",
"middle_name": "NAZARENO",
"name_prefix": "Mr.",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-10-07",
"last_updated": "2009-10-07",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "UT",
"license": "6417919-3501",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Salt Lake, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.