Provider Demographics
NPI:1962428011
Name:EVANEGO, JODI ANNE (LCSW)
Entity type:Individual
Prefix:
First Name:JODI
Middle Name:ANNE
Last Name:EVANEGO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JODI
Other - Middle Name:ANNE
Other - Last Name:BOYCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:123 SZYMANSKI DR
Mailing Address - Street 2:
Mailing Address - City:SPOTSWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08884
Mailing Address - Country:US
Mailing Address - Phone:732-416-9060
Mailing Address - Fax:
Practice Address - Street 1:120 JOHN ST
Practice Address - Street 2:STE 6
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08542
Practice Address - Country:US
Practice Address - Phone:609-924-2098
Practice Address - Fax:609-924-7826
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC04302900104100000X
NJ5833611041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker
Not Answered1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool