Provider Demographics
NPI:1093127334
Name:SWALLOW, JUDITH (LCAT)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:
Last Name:SWALLOW
Suffix:
Gender:F
Credentials:LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 HARRINGTON ST
Mailing Address - Street 2:
Mailing Address - City:NEW PALTZ
Mailing Address - State:NY
Mailing Address - Zip Code:12561-1203
Mailing Address - Country:US
Mailing Address - Phone:845-706-9099
Mailing Address - Fax:
Practice Address - Street 1:25 HARRINGTON ST
Practice Address - Street 2:
Practice Address - City:NEW PALTZ
Practice Address - State:NY
Practice Address - Zip Code:12561-1203
Practice Address - Country:US
Practice Address - Phone:845-706-9099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-21
Last Update Date:2014-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000600101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000600OtherLCAT