Provider Demographics
NPI:1013158492
Name:MUGAVERO SWICK, JAN E (LPC)
Entity Type:Individual
Prefix:
First Name:JAN
Middle Name:E
Last Name:MUGAVERO SWICK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 FAIRBANKS AVE
Mailing Address - Street 2:
Mailing Address - City:PHILLIPSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08865-1435
Mailing Address - Country:US
Mailing Address - Phone:908-619-1769
Mailing Address - Fax:
Practice Address - Street 1:502 FAIRBANKS AVE
Practice Address - Street 2:
Practice Address - City:PHILLIPSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08865-1435
Practice Address - Country:US
Practice Address - Phone:908-619-1769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-16
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC002956101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0161756Medicaid