Provider Demographics
NPI:1972564573
Name:EVERS PSYCHOLOGICAL ASSOCIATES PC
Entity type:Organization
Organization Name:EVERS PSYCHOLOGICAL ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:EVERS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:732-528-5334
Mailing Address - Street 1:2421 ATLANTIC AVENUE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:MANASQUAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08736-1000
Mailing Address - Country:US
Mailing Address - Phone:732-528-5334
Mailing Address - Fax:732-528-5279
Practice Address - Street 1:2421 ATLANTIC AVENUE
Practice Address - Street 2:SUITE 102
Practice Address - City:MANASQUAN
Practice Address - State:NJ
Practice Address - Zip Code:08736-1000
Practice Address - Country:US
Practice Address - Phone:732-528-5334
Practice Address - Fax:732-528-5279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-31
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00176500103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ071699Medicare PIN