Active NPI
John Adam Evelyn, LCSW
- Clinical Social Worker
- Viera, FL
National Provider Identifier
1477091551
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- SW 13159
- Practice address
- 2900 Veterans Way
Viera, FL 32940-8007 - Phone
- (321) 637-3788
- Fax
- (321) 637-6377
- NPI assigned
- Feb 8, 2017
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | SW 13159 | FL | Primary |
Addresses
Primary practice location
2900 Veterans Way
Viera, FL 32940-8007
Mailing address
2900 Veterans Way
Viera, FL 32940-8007
Phone (321) 637-3788
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SW 13159 | FL | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1486512000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1623888000000",
"number": "1477091551",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2900 VETERANS WAY",
"city": "VIERA",
"state": "FL",
"postal_code": "329408007",
"telephone_number": "321-637-3788",
"fax_number": "321-637-6377"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2900 VETERANS WAY",
"city": "VIERA",
"state": "FL",
"postal_code": "329408007",
"telephone_number": "321-637-3788",
"fax_number": "321-637-6377"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EVELYN",
"first_name": "JOHN",
"middle_name": "ADAM",
"name_prefix": "Mr.",
"credential": "LCSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-02-08",
"last_updated": "2021-06-17",
"certification_date": "2021-06-17",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "FL",
"license": "SW 13159",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Viera, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.