Healthcare Provider Details

I. General information

NPI: 1902463789
Provider Name (Legal Business Name): SWLCSW LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2019
Last Update Date: 05/29/2024
Certification Date: 05/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

151 E 3RD ST
PALISADE CO
81526
US

IV. Provider business mailing address

1 KALISA WAY STE 101
PARAMUS NJ
07652-3508
US

V. Phone/Fax

Practice location:
  • Phone: 970-778-1755
  • Fax:
Mailing address:
  • Phone: 888-948-6789
  • Fax: 877-345-3501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: SUSAN A WILLIAMS
Title or Position: OWNER
Credential: LCSW
Phone: 970-778-1755