Healthcare Provider Details

I. General information

NPI: 1154046969
Provider Name (Legal Business Name): ERIK SWANSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2022
Last Update Date: 10/05/2022
Certification Date: 10/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 VALLEY HEALTH PLZ
PARAMUS NJ
07652-3607
US

IV. Provider business mailing address

32 WALNUT CRES
MONTCLAIR NJ
07042-4917
US

V. Phone/Fax

Practice location:
  • Phone: 201-986-5000
  • Fax:
Mailing address:
  • Phone: 973-600-6840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37AC00634500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: