MEDICARE: MR. WAYNE KEITH ROWAN SOCIAL WORKER(MASTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	076837-1	NY
2	101YA0400X	Addiction (Substance Use Disorder) Counselor		FL

General Provider Information

NPI Number	:	1336372812
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WAYNE KEITH ROWAN SOCIAL WORKER(MASTER

Provider Business Mailing Address
First Line	:	79-01 BROADWAY H3 ROOM 129
Second Line	:	ELMHURST HOSPITAL CENTER
City	:	ELMHURST
State	:	NY
Zip	:	11373-1368
Country	:	US
Telephone Number	:	718-334-1097
Fax Number	:	718-334-5796

Provider Business Practice Location Address
First Line	:	3181 DAVIE BLVD
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33312-2728
Country	:	US
Telephone Number	:	954-533-1670
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2009
Last Update Date	:	05/01/2019

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