Provider Demographics
NPI:1073750931
Name:SWANN, WILLIAM S (LICSW)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:S
Last Name:SWANN
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 DEPOT ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-5130
Mailing Address - Country:US
Mailing Address - Phone:413-499-4090
Mailing Address - Fax:413-499-1844
Practice Address - Street 1:34 DEPOT ST
Practice Address - Street 2:SUITE 201
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-5130
Practice Address - Country:US
Practice Address - Phone:413-499-4090
Practice Address - Fax:413-499-1844
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-14
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1144261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD4H173OtherMEDICARE SERVICES/PART B