=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134043342
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EVOLVEPATH MENTAL HEALTH LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/10/2026
-----------------------------------------------------
Last Update Date | 08/10/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 830 MORRIS TPKE
-----------------------------------------------------
City | SHORT HILLS
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07078-2625
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-884-9757
-----------------------------------------------------
Fax | 908-667-1815
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 719 SUBURBAN RD
-----------------------------------------------------
City | UNION
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07083-7428
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-884-9757
-----------------------------------------------------
Fax | 908-667-1815
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | APN/OWNER
-----------------------------------------------------
Name | PRISCA CHIMEZIE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 908-884-9757
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Registered Nurse
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------