Provider Demographics
NPI:1063657229
Name:SWANSON, AMANDA ELIZABETH (LMSW-CC)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:ELIZABETH
Last Name:SWANSON
Suffix:
Gender:F
Credentials:LMSW-CC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820 MAIN ST.
Mailing Address - Street 2:
Mailing Address - City:WESTBROOK
Mailing Address - State:ME
Mailing Address - Zip Code:04092
Mailing Address - Country:US
Mailing Address - Phone:207-854-1030
Mailing Address - Fax:207-854-1001
Practice Address - Street 1:820 MAIN ST.
Practice Address - Street 2:
Practice Address - City:WESTBROOK
Practice Address - State:ME
Practice Address - Zip Code:04092
Practice Address - Country:US
Practice Address - Phone:207-854-1030
Practice Address - Fax:207-854-1001
Is Sole Proprietor?:No
Enumeration Date:2008-12-02
Last Update Date:2008-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC11874104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker