MEDICARE: COWELL COUNSELING PC GROUP LLC

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	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1740135128
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COWELL COUNSELING PC GROUP LLC

Provider Business Mailing Address
First Line	:	630 HERMAN RD STE 12
Second Line	:
City	:	JACKSON
State	:	NJ
Zip	:	08527-3081
Country	:	US
Telephone Number	:	732-523-1295
Fax Number	:

Provider Business Practice Location Address
First Line	:	630 HERMAN RD STE 12
Second Line	:
City	:	JACKSON
State	:	NJ
Zip	:	08527-3081
Country	:	US
Telephone Number	:	732-523-1295
Fax Number	:

Authorized Official
Title or Position	:	ADMIN
Name	:	JOEL REINER
Credential	:
Telephone Number	:	732-523-1295

Provider Enumeration Date	:	03/02/2026
Last Update Date	:	03/02/2026

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