Provider Demographics
NPI:1093443186
Name:SWIFT, MARY MARJORIE (LCSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:MARJORIE
Last Name:SWIFT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:
Other - Last Name:SWIFT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:1022 24TH ST
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34234-7303
Mailing Address - Country:US
Mailing Address - Phone:478-542-0686
Mailing Address - Fax:
Practice Address - Street 1:1022 24TH ST
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34234-7303
Practice Address - Country:US
Practice Address - Phone:478-542-0686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-08
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW175301041C0700X
VA09040152851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical