Active NPI
Kristin L Evans, LICSW
- Clinical Social Worker
- Northampton, MA
National Provider Identifier
1790841856
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 120000
- Practice address
- 21 Belmont Avenue
Northampton, MA 01060 - Phone
- (413) 585-2800
- NPI assigned
- Dec 30, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 645LCSW | MT | |
| Clinical Social Worker | 1041C0700X | LSW4581 | TN | |
| Clinical Social Worker | 1041C0700X | 120000 | MA | Primary |
Addresses
Primary practice location
21 Belmont Avenue
Northampton, MA 01060
Mailing address
21 Belmont Avenue
Northampton, MA 01060
Phone (413) 585-2800
Other practice location 1
214 E Mendenhall St
Bozeman, MT 59715-3638
Phone (406) 922-0861
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 70815 | Other | MT | BLUE CROSS |
| 0503319 | Medicaid | MT |
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 |
|---|---|---|---|
| 120000 | MA | MD | Clinical Social Worker |
| 645LCSW | MT | MD | Clinical Social Worker |
| LSW4581 | TN | MD | Clinical Social Worker |
| 645 | MT | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167436800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1735603200000",
"number": "1790841856",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "21 BELMONT AVENUE",
"city": "NORTHAMPTON",
"state": "MA",
"postal_code": "01060",
"telephone_number": "413-585-2800"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "21 BELMONT AVENUE",
"city": "NORTHAMPTON",
"state": "MA",
"postal_code": "01060",
"telephone_number": "413-585-2800"
}
],
"practiceLocations": [
{
"address_1": "214 E Mendenhall St",
"address_purpose": "LOCATION",
"city": "Bozeman",
"state": "MT",
"postal_code": "597153638",
"country_code": "US",
"telephone_number": "406-922-0861",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "EVANS",
"first_name": "KRISTIN",
"middle_name": "L",
"credential": "LICSW",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-12-30",
"last_updated": "2024-12-31",
"certification_date": "2024-12-20",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MT",
"license": "645LCSW",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "TN",
"license": "LSW4581",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MA",
"license": "120000",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS",
"identifier": "70815",
"state": "MT"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0503319",
"state": "MT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Northampton, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.