Provider Demographics
NPI:1679256291
Name:EVELYN, SPENCER (RBT)
Entity Type:Individual
Prefix:
First Name:SPENCER
Middle Name:
Last Name:EVELYN
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 FINDERNE AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-3670
Mailing Address - Country:US
Mailing Address - Phone:908-392-4976
Mailing Address - Fax:484-377-2100
Practice Address - Street 1:120 FINDERNE AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEWATER
Practice Address - State:NJ
Practice Address - Zip Code:08807-3670
Practice Address - Country:US
Practice Address - Phone:908-392-4976
Practice Address - Fax:484-377-2100
Is Sole Proprietor?:No
Enumeration Date:2023-08-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJRBT-22-244074106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician