Healthcare Provider Details

I. General information

NPI: 1154240919
Provider Name (Legal Business Name): CASEY EVANS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2026
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 CHURCH RD
MOUNT LAUREL NJ
08054-2231
US

IV. Provider business mailing address

4201 CHURCH RD
MOUNT LAUREL NJ
08054-2231
US

V. Phone/Fax

Practice location:
  • Phone: 609-614-0596
  • Fax:
Mailing address:
  • Phone: 609-614-0596
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-2826185
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: