Provider Demographics
NPI:1962544460
Name:EVANGELISTA, ANDREW DANIEL (LCSW, LCADC)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:DANIEL
Last Name:EVANGELISTA
Suffix:
Gender:M
Credentials:LCSW, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:66 ROSELAND AVE
Mailing Address - Street 2:
Mailing Address - City:CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-5965
Mailing Address - Country:US
Mailing Address - Phone:973-226-4773
Mailing Address - Fax:973-226-4662
Practice Address - Street 1:66 ROSELAND AVE
Practice Address - Street 2:
Practice Address - City:CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006-5965
Practice Address - Country:US
Practice Address - Phone:973-226-4773
Practice Address - Fax:973-226-4662
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00073600101YA0400X
NJ44SC002041001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical