Healthcare Provider Details

I. General information

NPI: 1831076900
Provider Name (Legal Business Name): SWORD MIND CARE PROVIDERS, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2025
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 BROADWAY STE 1109
NEW YORK NY
10010-7192
US

IV. Provider business mailing address

169 MADISON AVE STE 15501
NEW YORK NY
10016-5101
US

V. Phone/Fax

Practice location:
  • Phone: 385-308-8034
  • Fax:
Mailing address:
  • Phone: 385-308-8034
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State

VIII. Authorized Official

Name: LAURA MELTON
Title or Position: PRESIDENT
Credential: PHD, ABPP
Phone: 385-262-7495