Provider Demographics
NPI:1124211958
Name:SWARTZ, MICHELLE L (LISW)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L
Last Name:SWARTZ
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:975 A FUJITEC DRIVE
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45036
Mailing Address - Country:US
Mailing Address - Phone:513-228-7800
Mailing Address - Fax:513-228-7848
Practice Address - Street 1:204 COOK RD
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45036-9600
Practice Address - Country:US
Practice Address - Phone:513-695-1357
Practice Address - Fax:513-695-2952
Is Sole Proprietor?:No
Enumeration Date:2007-08-24
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI-7001651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
11822112OtherCAQH #