Provider Demographics
NPI:1093826299
Name:SWAIN, BENJAMIN WILLSON (LICSW, ICADC,CADC II)
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:WILLSON
Last Name:SWAIN
Suffix:
Gender:M
Credentials:LICSW, ICADC,CADC II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9639 OXBRIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-3035
Mailing Address - Country:US
Mailing Address - Phone:301-613-2750
Mailing Address - Fax:301-386-3521
Practice Address - Street 1:600 W ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-1241
Practice Address - Country:US
Practice Address - Phone:301-613-2750
Practice Address - Fax:301-386-3521
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2009-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC10191-502101YA0400X
DCLC500780811041C0700X
MD132071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)