Healthcare Provider Details

I. General information

NPI: 1437847498
Provider Name (Legal Business Name): KATHLEEN ROSCOVICH LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2023
Last Update Date: 04/27/2023
Certification Date: 04/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

765 ROUTE 70 E BLDG A
MARLTON NJ
08053-2341
US

IV. Provider business mailing address

765 ROUTE 70 E BLDG A
MARLTON NJ
08053-2341
US

V. Phone/Fax

Practice location:
  • Phone: 856-797-4721
  • Fax:
Mailing address:
  • Phone: 856-797-4721
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05588100
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: