Provider Demographics
NPI:1154489243
Name:EVERS, SEAN R (PHD)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:R
Last Name:EVERS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2421 ATLANTIC AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MANASQUAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08736-1000
Mailing Address - Country:US
Mailing Address - Phone:732-528-5334
Mailing Address - Fax:
Practice Address - Street 1:2421 ATLANTIC AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:MANASQUAN
Practice Address - State:NJ
Practice Address - Zip Code:08736-1000
Practice Address - Country:US
Practice Address - Phone:732-528-5334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00176500103TC0700X, 103TF0200X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist