Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 44SC05273300 | NJ |
NPI | 1003182221 |
---|---|
Provider Name | Kristen K Evans |
First Address | Marlton, NJ 08053-3101 |
Second Address | Marlton, NJ 08053-3101 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2012 |
Last Update Date | 02/04/2012 |