Healthcare Provider Details

I. General information

NPI: 1669964185
Provider Name (Legal Business Name): ROWAN INTEGRATED SPECIAL NEEDS BH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2018
Last Update Date: 12/05/2022
Certification Date: 12/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 SALINA RD
SEWELL NJ
08080-4111
US

IV. Provider business mailing address

PO BOX 71356
PHILADELPHIA PA
19176-1356
US

V. Phone/Fax

Practice location:
  • Phone: 856-566-6034
  • Fax: 856-566-6208
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: KELIYVETTE WORKMAN
Title or Position: DIRECTOR OF MANAGED CARE & CONTRACT
Credential:
Phone: 856-566-6831