Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | ||
N | 103T00000X | Psychologist | ||
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | PY10910 | FL |
NPI | 1053929950 |
---|---|
Provider Name | Melissa Anne Swartz |
First Address | Fort Myers, FL 33902-2147 |
Second Address | Fort Myers, FL 33908-3618 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/07/2020 |
Last Update Date | 30/03/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
108054600 | (05) | FL |