Provider Demographics
NPI:1598362469
Name:EVANS, KATHRINE (LMFT)
Entity Type:Individual
Prefix:
First Name:KATHRINE
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 NEPTUNE DR
Mailing Address - Street 2:
Mailing Address - City:MANAHAWKIN
Mailing Address - State:NJ
Mailing Address - Zip Code:08050-1751
Mailing Address - Country:US
Mailing Address - Phone:609-618-4425
Mailing Address - Fax:
Practice Address - Street 1:216 NEPTUNE DR
Practice Address - Street 2:
Practice Address - City:MANAHAWKIN
Practice Address - State:NJ
Practice Address - Zip Code:08050-1751
Practice Address - Country:US
Practice Address - Phone:609-618-4425
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-05
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMF000820106H00000X
NJ37FI00187700106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist