Provider Demographics
NPI:1134437841
Name:FALDA, EVIE L
Entity type:Individual
Prefix:DR
First Name:EVIE
Middle Name:L
Last Name:FALDA
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:EVIE
Other - Middle Name:L
Other - Last Name:FALDA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:17 HOOVER AVE
Mailing Address - Street 2:
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-2318
Mailing Address - Country:US
Mailing Address - Phone:917-439-0404
Mailing Address - Fax:718-677-0977
Practice Address - Street 1:17 HOOVER AVE
Practice Address - Street 2:
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-2318
Practice Address - Country:US
Practice Address - Phone:917-439-0404
Practice Address - Fax:718-677-0977
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-15
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY7954103T00000X
NJ35SI00628900103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist