Provider Demographics
NPI:1407166622
Name:SWIFT, JACQUELINE J (PHD, LCADC)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:J
Last Name:SWIFT
Suffix:
Gender:F
Credentials:PHD, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 N BROADWAY
Mailing Address - Street 2:
Mailing Address - City:PITMAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08071-1034
Mailing Address - Country:US
Mailing Address - Phone:856-582-0001
Mailing Address - Fax:
Practice Address - Street 1:8 N BROADWAY
Practice Address - Street 2:
Practice Address - City:PITMAN
Practice Address - State:NJ
Practice Address - Zip Code:08071-1034
Practice Address - Country:US
Practice Address - Phone:856-582-0001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-21
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00113800101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional