Provider Demographics
NPI:1740774769
Name:SWIFT, EDWOUINE M (MS)
Entity Type:Individual
Prefix:MS
First Name:EDWOUINE
Middle Name:M
Last Name:SWIFT
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 FLINT PL
Mailing Address - Street 2:
Mailing Address - City:ELMONT
Mailing Address - State:NY
Mailing Address - Zip Code:11003-3613
Mailing Address - Country:US
Mailing Address - Phone:347-470-5507
Mailing Address - Fax:
Practice Address - Street 1:115 FLINT PL
Practice Address - Street 2:
Practice Address - City:ELMONT
Practice Address - State:NY
Practice Address - Zip Code:11003-3613
Practice Address - Country:US
Practice Address - Phone:347-470-5507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-22
Last Update Date:2018-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst