Provider Demographics
NPI:1306574801
Name:SWIERAT, SHANNON MARIE (LMSW)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:MARIE
Last Name:SWIERAT
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:306 CAPTAINS DR
Mailing Address - Street 2:
Mailing Address - City:WEST BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11704-8233
Mailing Address - Country:US
Mailing Address - Phone:315-601-8749
Mailing Address - Fax:
Practice Address - Street 1:5550 MERRICK RD
Practice Address - Street 2:
Practice Address - City:MASSAPEQUA
Practice Address - State:NY
Practice Address - Zip Code:11758-6238
Practice Address - Country:US
Practice Address - Phone:315-601-8749
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-11
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY115039104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker