Provider Demographics
NPI:1114482072
Name:SWAIN, BREANA NICOLE (LCSW)
Entity Type:Individual
Prefix:
First Name:BREANA
Middle Name:NICOLE
Last Name:SWAIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 THE HAMLET APT G
Mailing Address - Street 2:
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-7003
Mailing Address - Country:US
Mailing Address - Phone:617-449-8018
Mailing Address - Fax:
Practice Address - Street 1:576 STATE ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01109-4104
Practice Address - Country:US
Practice Address - Phone:413-733-0481
Practice Address - Fax:413-733-1315
Is Sole Proprietor?:No
Enumeration Date:2019-02-05
Last Update Date:2019-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA224576101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health