| Doctor Name: | MARK EVERDS |
| NPI Number: | 1386876779 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | L.I.C.S.W. |
| License Number: | 114547 |
| Business Practice Address: | 97 Holmes Street, 2nd Floor North Quincy, MA - 02171 |
| Business Phone Number: | 6174625479 |
| Business Fax Number: | 6177701174 |
| Mailing Address: | 14 Waldo Ave # 1r, SOMERVILLE |
| State: | MA |
| Postal Code: | 021434319 |
| Phone Number: | 6174625479 |
| Fax Number: | |
| NPI Enumeration Date: | 08/18/2009 |
| NPI Last Update Date: | 08/28/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 114547 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |