Provider Demographics
NPI:1114398468
Name:SWISWA, RUVARASHE (LABA, LCSW)
Entity Type:Individual
Prefix:
First Name:RUVARASHE
Middle Name:
Last Name:SWISWA
Suffix:
Gender:F
Credentials:LABA, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 LANGDON AVE
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-1478
Mailing Address - Country:US
Mailing Address - Phone:978-608-3550
Mailing Address - Fax:
Practice Address - Street 1:251 W CENTRAL ST STE 25
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760
Practice Address - Country:US
Practice Address - Phone:508-653-4820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-13
Last Update Date:2018-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA220546104100000X
MA2068103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No104100000XBehavioral Health & Social Service ProvidersSocial Worker