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EVOLUTION MIND, LLC
NPI 1912428905
Clinic/Center - Mental Health (Including Community Mental Health Center) in Maplewood, NJ

Active since June 29, 2017
2130 MILLBURN AVE STE D2, MAPLEWOOD, NJ 07040(973) 801-1801(908) 964-0809 Get Directions Write a Review

NPPES record last updated: October 23, 2017. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Oct 23, 2017, Jun 29, 2017 (2 updates tracked since 2017).

About Evolution Mind, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

EVOLUTION MIND, LLC (NPI 1912428905) is a healthcare organization registered as a mental health (including community mental health center) in Maplewood, New Jersey and active in the NPI registry since June 2017. The organization lists Kira Baskerville-williams, Co-owner, as its authorized official.

NPPES Registry Identity

NPI1912428905
Entity TypeOrganization
Primary Taxonomy261QM0801X
Legal Business NameEVOLUTION MIND, LLC
Location Address2130 MILLBURN AVE STE D2Maplewood, NJ 07040-3749
Mailing Address1286 Marcella DrUnion, NJ 07083-6243 · (973) 801-1801
Phone(973) 801-1801
Fax(908) 964-0809
Organization SubpartNo
Authorized OfficialKira Baskerville-williamsCo-owner · (973) 801-1801
Enumeration DateJune 29, 2017
Last NPPES UpdateOctober 23, 20172 updates tracked since enumeration
✔ NPI 1912428905 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyClinic/Center · Mental Health (Including Community Mental Health Center)Ambulatory Health Care Facilities
Taxonomy Code261QM0801X
2130 MILLBURN AVE STE D2, Maplewood, NJ 07040
Open in Google Maps ↗

Other Identifiers 1

Other1336699529NJ · Npi

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Evolution Mind, Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Evolution Mind, LLC, which bills Medicare for the services this clinician delivers.

Clinician (1)

Kira Baskerville-Williams, LCSW
Clinical Social Worker
NPI 1336699529
2130 MILLBURN AVE STE D-2
Maplewood, NJ 07040
(973) 801-1801
✔ PECOS✔ Accepts MedicareSame address

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Evolution Mind, LLC's NPI number?

The NPI number for Evolution Mind, LLC is 1912428905. It was assigned to this organization in the NPPES registry on June 29, 2017.

Where is Evolution Mind, LLC located?

Evolution Mind, LLC is located at 2130 Millburn Ave Ste D2, Maplewood, NJ 07040. The listed phone number is (973) 801-1801.

What is Evolution Mind, LLC's specialty?

The primary specialty registered for this NPI is Clinic/Center, specializing in Mental Health (Including Community Mental Health Center), with taxonomy code 261QM0801X.

Is Evolution Mind, LLC enrolled in Medicare?

Yes. Evolution Mind, LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Evolution Mind, LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Clinical Social Worker) reassigns their Medicare billing to Evolution Mind, LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

When was this NPI record last updated?

The NPPES record for Evolution Mind, LLC was last updated on October 23, 2017. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.