Healthcare Provider Details

I. General information

NPI: 1235973066
Provider Name (Legal Business Name): JOELLE VINCES-RODRIGUEZ MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2024
Last Update Date: 09/25/2026
Certification Date: 09/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6821 BLACK HORSE PIKE
EGG HARBOR TOWNSHIP NJ
08234-4101
US

IV. Provider business mailing address

110 BUCHANAN AVE
GALLOWAY NJ
08205-4594
US

V. Phone/Fax

Practice location:
  • Phone: 844-422-3632
  • Fax:
Mailing address:
  • Phone: 609-864-6636
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC06695600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: