Provider Demographics
NPI:1295196343
Name:SWAIN, ANGELA (LMSW)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:SWAIN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6666 BABCOCK HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:BATH
Mailing Address - State:NY
Mailing Address - Zip Code:14810-7773
Mailing Address - Country:US
Mailing Address - Phone:607-776-3822
Mailing Address - Fax:
Practice Address - Street 1:6666 BABCOCK HOLLOW RD
Practice Address - Street 2:
Practice Address - City:BATH
Practice Address - State:NY
Practice Address - Zip Code:14810-7773
Practice Address - Country:US
Practice Address - Phone:607-776-3822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-17
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY092797-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical