MEDICARE: ROWAN COLLEGE OF SOUTH JERSEY - CUMBERLAND CAMPUS

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YP2500X	Professional Counselor
2	106H00000X	Marriage & Family Therapist
3	104100000X	Social Worker

General Provider Information

NPI Number	:	1821631987
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROWAN COLLEGE OF SOUTH JERSEY - CUMBERLAND CAMPUS

Provider Business Mailing Address
First Line	:	3322 COLLEGE DRIVE
Second Line	:
City	:	VINELAND
State	:	NJ
Zip	:	08360
Country	:	US
Telephone Number	:	856-200-4548
Fax Number	:	856-690-0812

Provider Business Practice Location Address
First Line	:	3322 COLLEGE DRIVE
Second Line	:
City	:	VINELAND
State	:	NJ
Zip	:	08360
Country	:	US
Telephone Number	:	856-200-4548
Fax Number	:	856-690-0812

Authorized Official
Title or Position	:	VICE PRESIDENT & CHIEF ADMINISTRATI
Name	:	DR. JAMES R. PICCONE
Credential	:	ED.D.
Telephone Number	:	856-200-4547

Provider Enumeration Date	:	10/22/2019
Last Update Date	:	10/22/2019

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