Provider Demographics
NPI:1225671134
Name:SWED, MAC (MHC -LP)
Entity Type:Individual
Prefix:MR
First Name:MAC
Middle Name:
Last Name:SWED
Suffix:
Gender:M
Credentials:MHC -LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2055 E 9TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11223-4130
Mailing Address - Country:US
Mailing Address - Phone:848-444-3914
Mailing Address - Fax:
Practice Address - Street 1:1955 MCDONALD AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-1805
Practice Address - Country:US
Practice Address - Phone:718-787-1600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-23
Last Update Date:2019-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP103084101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty