Basic Information
| Provider Information | |||||||||
| NPI: | 1811192743 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SWANTEK | ||||||||
| FirstName: | MELISSA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MSED | ||||||||
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| Mailing Information | |||||||||
| Address1: | 711 BELMONT AVE | ||||||||
| Address2: | |||||||||
| City: | YOUNGSTOWN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 445021039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3307932487 | ||||||||
| FaxNumber: | 3307435748 | ||||||||
| Practice Location | |||||||||
| Address1: | 142 JAVIT CT | ||||||||
| Address2: | |||||||||
| City: | YOUNGSTOWN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 445152409 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3307932487 | ||||||||
| FaxNumber: | 3307934559 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2007 | ||||||||
| LastUpdateDate: | 04/12/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/12/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | E0004222 | OH | N | Behavioral Health & Social Service Providers | Counselor | Professional | 101YM0800X | E.0004222 | OH | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.