Evolution Mind, LLC

Primary specialty

Mental Health Clinic/Center (Including Community Mental Health Center)Taxonomy code 261QM0801X

Legal business name

EVOLUTION MIND, LLC

Practice address

2130 Millburn Ave Ste D2
Maplewood, NJ 07040-3749

Phone

(973) 801-1801

Fax

(908) 964-0809

NPI assigned

Jun 29, 2017

Organization subpart

No

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

Authorized official

Name

Kira Baskerville-Williams, MSW, LCSW, ED.SNPI 1336699529

Title

Co-Owner

Phone

(973) 801-1801

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NJ

Enrollment records 1

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kira Baskerville-Williams, LCSW

  • Clinical Social Worker
  • Maplewood, NJ
  • NPI 1336699529
  Medicare reassignment NPD Authorized official
• Paula Wilson-Howell, PSY.D; LAC

  • Counseling Psychologist
  • Maplewood, NJ
  • NPI 1174044168
  NPD
• Ruby Baskerville, LCSW

  • Clinical Social Worker
  • Maplewood, NJ
  • NPI 1598215790
  NPD (past)

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

{
    "created_epoch": "1498694400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1508716800000",
    "number": "1912428905",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1286 MARCELLA DR",
            "city": "UNION",
            "state": "NJ",
            "postal_code": "070836243",
            "telephone_number": "973-801-1801"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2130 MILLBURN AVE STE D2",
            "city": "MAPLEWOOD",
            "state": "NJ",
            "postal_code": "070403749",
            "telephone_number": "973-801-1801",
            "fax_number": "908-964-0809"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EVOLUTION MIND, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-06-29",
        "last_updated": "2017-10-23",
        "status": "A",
        "authorized_official_last_name": "BASKERVILLE-WILLIAMS",
        "authorized_official_first_name": "KIRA",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "973-801-1801",
        "authorized_official_credential": "MSW, LCSW, ED.S"
    },
    "taxonomies": [
        {
            "code": "261QM0801X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Mental Health (Including Community Mental Health Center)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1336699529",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Essex Pathology, LLC.
• Esther O Udechukwu
• Jessica Lynne Estreicher, LSW
• Danielle Etienne, RN
• Syvon Evans
• Omorovbiye Eweka
• Exas Nutrition PLLC
• Callie Elizabeth Exas, RDN, CDN
• Emmanuel Chimezie Ezeri
• Debra Feinberg, MSW

• Mental Health Clinic/Center (Including Community Mental Health Center) in Maplewood, NJ
• Providers in Maplewood, NJ by specialty
• Mental Health Clinic/Center (Including Community Mental Health Center) in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.