=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720974496
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JAMES BROWN COWPERTHWAIT JR. LMSW
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/17/2025
-----------------------------------------------------
Last Update Date | 06/17/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11 EDGEHILL RD
-----------------------------------------------------
City | WEST ORANGE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07052-4939
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-912-6114
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 634 EAGLE ROCK AVE UNIT 262
-----------------------------------------------------
City | WEST ORANGE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07052-6803
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 908-912-6114
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 44SL07275100
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------