Healthcare Provider Details

I. General information

NPI: 1427103233
Provider Name (Legal Business Name): REGGIE BRUCE SWENSON LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 CAMPBELL AVE
SUFFERN NY
10901-6301
US

IV. Provider business mailing address

39 S AIRMONT RD
SUFFERN NY
10901-7134
US

V. Phone/Fax

Practice location:
  • Phone: 845-368-5222
  • Fax: 845-368-5322
Mailing address:
  • Phone: 845-357-3944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR017358-1
License Number StateNY

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: