1003889486 NPI number — MR. GERALD A. SWENSON LCSW

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003889486 NPI number — MR. GERALD A. SWENSON LCSW

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

SWENSON

Provider First Name:

GERALD

Provider Middle Name:

A.

Provider Name Prefix Text:

MR.

Provider Name Suffix Text:

Provider Credential Text:

LCSW

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1003889486

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

07/08/2007

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

2834 HICKORY ST

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

YORKTOWN HEIGHTS

Provider Business Mailing Address State Name:

NY

Provider Business Mailing Address Postal Code:

10598-2730

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

914-245-7598

Provider Business Mailing Address Fax Number:

914-245-3574

Provider First Line Business Practice Location Address:

1940 COMMERCE ST

Provider Second Line Business Practice Location Address:

SUITE 109

Provider Business Practice Location Address City Name:

YORKTOWN HEIGHTS

Provider Business Practice Location Address State Name:

NY

Provider Business Practice Location Address Postal Code:

10598-4428

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

914-245-7598

Provider Business Practice Location Address Fax Number:

914-245-3574

Provider Enumeration Date:

02/08/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 1041C0700X , with the licence number:  R040844 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
• Taxonomy code: 106H00000X , with the licence number: R040844 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

• Identifier: 01546152 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
• Identifier: 393384 . This is a "MVP" identifier . This identifiers is of the category "OTHER".
• Identifier: 5C3147 . This is a "HEALTHNET" identifier . This identifiers is of the category "OTHER".
• Identifier: 7484380 . This is a "EMPIRE VALUE OPTIONS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: R040844 . This is a "HIP OF NY" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 1031500 . This is a "BEACON HEALTH STRATEGIES" identifier . This identifiers is of the category "OTHER".
• Identifier: 6251182 . This is a "UNITED BEHAVIORAL HEALTH" identifier . This identifiers is of the category "OTHER".
• Identifier: 7936068 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
• Identifier: 212049 . This is a "MHN" identifier . This identifiers is of the category "OTHER".
• Identifier: P651419 . This is a "OXFORD" identifier . This identifiers is of the category "OTHER".