Provider Demographics
NPI:1336372812
Name:ROWAN, WAYNE KEITH (SOCIAL WORKER(MASTER)
Entity Type:Individual
Prefix:MR
First Name:WAYNE
Middle Name:KEITH
Last Name:ROWAN
Suffix:
Gender:M
Credentials:SOCIAL WORKER(MASTER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:79-01 BROADWAY H3 ROOM 129
Mailing Address - Street 2:ELMHURST HOSPITAL CENTER
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-1368
Mailing Address - Country:US
Mailing Address - Phone:718-334-1097
Mailing Address - Fax:718-334-5796
Practice Address - Street 1:3181 DAVIE BLVD
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33312-2728
Practice Address - Country:US
Practice Address - Phone:954-533-1670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-31
Last Update Date:2019-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY076837-1104100000X
FL101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker