Provider Demographics
NPI:1417341900
Name:CUSH, EVANGELIA JOSEPHINE (BSW)
Entity type:Individual
Prefix:MRS
First Name:EVANGELIA
Middle Name:JOSEPHINE
Last Name:CUSH
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:EVANGELIA
Other - Middle Name:J
Other - Last Name:CUSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RBT
Mailing Address - Street 1:20 PIERPONT PLACE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10314
Mailing Address - Country:US
Mailing Address - Phone:347-733-9393
Mailing Address - Fax:
Practice Address - Street 1:300 CORPORATE CENTER DR
Practice Address - Street 2:
Practice Address - City:MANALAPAN
Practice Address - State:NJ
Practice Address - Zip Code:07726-8736
Practice Address - Country:US
Practice Address - Phone:866-417-8669
Practice Address - Fax:844-444-0964
Is Sole Proprietor?:No
Enumeration Date:2015-03-24
Last Update Date:2024-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJRBT-23-293389106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician