MEDICARE: JOELLE VINCES-RODRIGUEZ MSW, LSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	44SL06252400	NJ

General Provider Information

NPI Number	:	1235973066
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOELLE VINCES-RODRIGUEZ MSW, LSW

Provider Business Mailing Address
First Line	:	110 BUCHANAN AVE
Second Line	:
City	:	GALLOWAY
State	:	NJ
Zip	:	08205-4594
Country	:	US
Telephone Number	:	609-864-6636
Fax Number	:

Provider Business Practice Location Address
First Line	:	6821 BLACK HORSE PIKE
Second Line	:
City	:	EGG HARBOR TOWNSHIP
State	:	NJ
Zip	:	08234-4101
Country	:	US
Telephone Number	:	844-422-3632
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/25/2024
Last Update Date	:	06/25/2024

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