Provider Demographics
NPI:1083388961
Name:AGYARE, EVELYN
Entity Type:Individual
Prefix:MISS
First Name:EVELYN
Middle Name:
Last Name:AGYARE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07860-1006
Mailing Address - Country:US
Mailing Address - Phone:973-930-3545
Mailing Address - Fax:
Practice Address - Street 1:101 TERRACE AVE #1A
Practice Address - Street 2:SAME
Practice Address - City:HASBROUCK HTS
Practice Address - State:NJ
Practice Address - Zip Code:07604
Practice Address - Country:US
Practice Address - Phone:197-393-0354
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-04
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ87-1655767.Medicaid