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General NPI Number Information
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NPI Number | 1225594286
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Entity Type | Organization
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Legal Business Name | ROWAN INTEGRATED SPECIAL NEEDS BH
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Dates
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Enumeration Date | 02/14/2019
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Last Update Date | 12/05/2022
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Provider Practice Location Address
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Address Line | 550 SALINA RD
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City | SEWELL
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State | NJ
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Zip | 08080-4111
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Country | US
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Telephone | 856-566-6034
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Fax | 856-566-6208
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Provider Business Mailing Address
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Address Line | PO BOX 71356
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City | PHILADELPHIA
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State | PA
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Zip | 19176-1356
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF MANAGED CARE
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Name | KELIYVETTE WORKMAN
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Credential |
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Telephone | 856-566-6831
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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