Healthcare Provider Details

I. General information

NPI: 1730562455
Provider Name (Legal Business Name): ROWAN INTEGRATED SPECIAL NEEDS BH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2015
Last Update Date: 12/05/2022
Certification Date: 12/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1474 TANYARD 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: 856-566-6413
  • Fax: 856-566-2797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

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