Provider Demographics
NPI:1003182221
Name:EVANS, KRISTEN K (MSS, LCSW)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:K
Last Name:EVANS
Suffix:
Gender:F
Credentials:MSS, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 EVES DRIVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-3101
Mailing Address - Country:US
Mailing Address - Phone:856-596-1600
Mailing Address - Fax:856-552-2224
Practice Address - Street 1:5 EVES DRIVE
Practice Address - Street 2:SUITE 300
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-3101
Practice Address - Country:US
Practice Address - Phone:856-596-1600
Practice Address - Fax:856-552-2224
Is Sole Proprietor?:No
Enumeration Date:2012-04-02
Last Update Date:2012-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC05273300104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker