Provider Demographics
NPI:1669209755
Name:SWANKOSKI, ALEXANDER (LAC)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:
Last Name:SWANKOSKI
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 TALLOWWOOD DR
Mailing Address - Street 2:
Mailing Address - City:EGG HARBOR TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08234-6724
Mailing Address - Country:US
Mailing Address - Phone:609-442-0368
Mailing Address - Fax:
Practice Address - Street 1:312 E WHITE HORSE PIKE
Practice Address - Street 2:
Practice Address - City:GALLOWAY
Practice Address - State:NJ
Practice Address - Zip Code:08205-9565
Practice Address - Country:US
Practice Address - Phone:609-652-1600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-13
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37AC00824800101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor