Healthcare Provider Details

I. General information

NPI: 1073086369
Provider Name (Legal Business Name): ROWANSOM CARES INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2019
Last Update Date: 01/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42 E LAUREL RD STE 1100
STRATFORD NJ
08084-1354
US

IV. Provider business mailing address

42 E LAUREL RD STE 3600
STRATFORD NJ
08084-1354
US

V. Phone/Fax

Practice location:
  • Phone: 856-566-7036
  • Fax:
Mailing address:
  • Phone: 856-566-6831
  • 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
Credential:
Phone: 856-566-6831