Provider Demographics
NPI:1104166289
Name:TWO RIVERS EVALUATION SERVICES
Entity type:Organization
Organization Name:TWO RIVERS EVALUATION SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARTHA
Authorized Official - Middle Name:ISOBEL
Authorized Official - Last Name:LUCZAK
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:866-784-1276
Mailing Address - Street 1:331 NEWMAN SPRINGS RD
Mailing Address - Street 2:BLDG. 1 4TH FL. SUITE 143
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-5688
Mailing Address - Country:US
Mailing Address - Phone:866-784-1276
Mailing Address - Fax:866-784-1276
Practice Address - Street 1:331 NEWMAN SPRINGS RD
Practice Address - Street 2:BLDG. 1 4TH FL. SUITE 143
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-5688
Practice Address - Country:US
Practice Address - Phone:866-784-1276
Practice Address - Fax:866-784-1276
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HALSTEAD STEWART INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-02-26
Last Update Date:2014-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00353500101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty