Healthcare Provider Details

I. General information

NPI: 1851108252
Provider Name (Legal Business Name): MEGAN K SWIFT LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2024
Last Update Date: 12/18/2024
Certification Date: 12/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 4TH AVE
BAY SHORE NY
11706-7908
US

IV. Provider business mailing address

49 N HOWELLS POINT RD
BELLPORT NY
11713-2310
US

V. Phone/Fax

Practice location:
  • Phone: 631-665-6707
  • Fax: 631-665-3564
Mailing address:
  • Phone: 631-618-1997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number125358-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: