Provider Demographics
NPI:1457715526
Name:STERN, EVAN (MS, LMHC, LPC)
Entity Type:Individual
Prefix:
First Name:EVAN
Middle Name:
Last Name:STERN
Suffix:
Gender:M
Credentials:MS, LMHC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 COLUMBIA ST
Mailing Address - Street 2:
Mailing Address - City:WOOD RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07075-2406
Mailing Address - Country:US
Mailing Address - Phone:914-282-5108
Mailing Address - Fax:
Practice Address - Street 1:112 COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:WOOD RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07075-2406
Practice Address - Country:US
Practice Address - Phone:914-257-7886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-05
Last Update Date:2023-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001747101YM0800X
NJ37PC00879400101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY001747OtherLICENSED MENTAL HEALTH COUNSELOR
NJ37PC00879400OtherPROFESSIONAL COUNSELOR