Provider Demographics
NPI:1295850402
Name:QUINTANA, EVELYN (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:
Last Name:QUINTANA
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2810 MORRIS AVE
Mailing Address - Street 2:SUITE 306
Mailing Address - City:UNION
Mailing Address - State:NJ
Mailing Address - Zip Code:07083-4850
Mailing Address - Country:US
Mailing Address - Phone:866-461-7541
Mailing Address - Fax:908-688-4893
Practice Address - Street 1:2810 MORRIS AVE
Practice Address - Street 2:SUITE 306
Practice Address - City:UNION
Practice Address - State:NJ
Practice Address - Zip Code:07083-4850
Practice Address - Country:US
Practice Address - Phone:866-461-7541
Practice Address - Fax:908-688-4893
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2011-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC052965001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ11-3806732OtherEIN # FOR SOLE PROPRIETOR