=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114446739
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SWIFT SOLUTIONS CONSULTANT SERVICES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/14/2017
-----------------------------------------------------
Last Update Date | 09/14/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 300 KIMBALL ST STE 106
-----------------------------------------------------
City | WOODBRIDGE
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07095-2506
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-600-8118
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 362 ALBERMARLE ST
-----------------------------------------------------
City | RAHWAY
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07065-2417
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 646-600-8118
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. MONIQUE SWIFT
-----------------------------------------------------
Credential | PSYD, LPC
-----------------------------------------------------
Telephone | 646-600-8118
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 37PC00349700
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------