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General NPI Number Information
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NPI Number | 1932065489
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Entity Type | Organization
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Legal Business Name | BLUE SWAN PSYCHIATRY, PLLC
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Dates
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Enumeration Date | 12/29/2025
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Last Update Date | 12/29/2025
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Provider Practice Location Address
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Address Line | 2178 POST RD STE 205
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City | WELLS
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State | ME
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Zip | 04090-4794
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Country | US
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Telephone | 207-216-1342
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Fax |
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Provider Business Mailing Address
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Address Line | 2178 POST RD STE 205
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City | WELLS
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State | ME
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Zip | 04090-4794
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Country | US
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Telephone | 207-216-1342
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Fax |
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Authorized Official
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Title or Position | OWNER/SOLE MEMBER
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Name | DOMANTAS MIKONIS
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Credential | DO
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Telephone | 207-216-1342
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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