Provider Demographics
NPI:1750515151
Name:STARK, EVA A (MS, LPC, PSYA)
Entity type:Individual
Prefix:
First Name:EVA
Middle Name:A
Last Name:STARK
Suffix:
Gender:F
Credentials:MS, LPC, PSYA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71 GRAND AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:07631-3532
Mailing Address - Country:US
Mailing Address - Phone:201-410-0291
Mailing Address - Fax:
Practice Address - Street 1:71 GRAND AVE STE 2
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-3532
Practice Address - Country:US
Practice Address - Phone:201-410-0291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-13
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJLPC00690101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional