Provider Demographics
NPI:1245748094
Name:MCSWAIN, CLIFTON II
Entity Type:Individual
Prefix:MR
First Name:CLIFTON
Middle Name:
Last Name:MCSWAIN
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 YAREMICH DR APT 7
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-2584
Mailing Address - Country:US
Mailing Address - Phone:203-556-7170
Mailing Address - Fax:
Practice Address - Street 1:70 YAREMICH DR APT 7
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-2584
Practice Address - Country:US
Practice Address - Phone:203-556-7170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-15
Last Update Date:2018-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior TechnicianGroup - Single Specialty