Provider Demographics
NPI:1124583745
Name:SWAB, JOSHUA TIMOTHY (LLMSW)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:TIMOTHY
Last Name:SWAB
Suffix:
Gender:M
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1545 KEYSTONE AVE
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48911-4039
Mailing Address - Country:US
Mailing Address - Phone:517-321-7663
Mailing Address - Fax:
Practice Address - Street 1:1545 KEYSTONE AVE
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48911-4039
Practice Address - Country:US
Practice Address - Phone:517-321-7663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-07
Last Update Date:2019-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011005631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical