Individual provider Active NPI

Colleen Evans, LCSW

  • Clinical Social Worker
  • Freehold, NJ
National Provider Identifier
1114122314
Registry record updated Nov 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
44SC05387700 Issued in NJ
Practice address
2 Paragon Way Ste 800
Freehold, NJ 07728-9573
Phone
(732) 393-8391
Fax
(732) 561-1721
NPI assigned
Jun 18, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 1, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 44SC05387700 NJ Primary
Addiction (Substance Use Disorder) Counselor 101YA0400X 37LC00167100 NJ

Addresses

Primary practice location

2 Paragon Way Ste 800
Freehold, NJ 07728-9573

Mailing address

2 Paragon Way Ste 800
Freehold, NJ 07728-9573
Phone (732) 393-8391

Other names 1

  • Colleen Neiman Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090528000402 NJ Practitioner - Clinical Social Worker 1557410271 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Social Worker
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Tree of Life Counseling Center, LLCGroup PAC ID 2668848425, 9 clinicians

Practice addresses (Care Compare)

2 Paragon Way
Suite 800
Freehold, NJ 07728-9573
Phone (732) 393-8391

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
37LC00167100NJMDAddiction (Substance Use Disorder) Counselor
44SC05387700NJMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Tree of Life Counseling Center, LLC Clinical CurrentSince Nov 1, 2024 Accepting new patients
Premier Care LLC Dba Elder Life Home Care LLC Past Accepting new patients

Locations

2 Paragon Way
Ste 800
Freehold, NJ 07728
Phone (732) 393-8391

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1182124800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730419200000",
    "number": "1114122314",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2 PARAGON WAY STE 800",
            "city": "FREEHOLD",
            "state": "NJ",
            "postal_code": "077289573",
            "telephone_number": "732-393-8391",
            "fax_number": "732-561-1721"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2 PARAGON WAY STE 800",
            "city": "FREEHOLD",
            "state": "NJ",
            "postal_code": "077289573",
            "telephone_number": "732-393-8391",
            "fax_number": "732-561-1721"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EVANS",
        "first_name": "COLLEEN",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-18",
        "last_updated": "2024-11-01",
        "certification_date": "2024-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NJ",
            "license": "44SC05387700",
            "primary": true
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NJ",
            "license": "37LC00167100",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "COLLEEN",
            "last_name": "NEIMAN",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Freehold, NJ

Sources for this page

Verify at the official NPI Registry.