Provider Demographics
NPI:1114122314
Name:EVANS, COLLEEN (LCSW)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:
Last Name:EVANS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:
Other - Last Name:NEIMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2 PARAGON WAY STE 800
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-9573
Mailing Address - Country:US
Mailing Address - Phone:732-393-8391
Mailing Address - Fax:732-561-1721
Practice Address - Street 1:2 PARAGON WAY STE 800
Practice Address - Street 2:
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-9573
Practice Address - Country:US
Practice Address - Phone:732-393-8391
Practice Address - Fax:732-561-1721
Is Sole Proprietor?:No
Enumeration Date:2007-06-18
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC053877001041C0700X
NJ37LC00167100101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)