Provider Demographics
NPI:1437107182
Name:SWIFT, TIFFANY A (LCSW-C)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:A
Last Name:SWIFT
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 191
Mailing Address - Street 2:
Mailing Address - City:PRINCESS ANNE
Mailing Address - State:MD
Mailing Address - Zip Code:21853-0191
Mailing Address - Country:US
Mailing Address - Phone:410-651-9852
Mailing Address - Fax:410-651-1279
Practice Address - Street 1:12145 ELM ST
Practice Address - Street 2:
Practice Address - City:PRINCESS ANNE
Practice Address - State:MD
Practice Address - Zip Code:21853-1358
Practice Address - Country:US
Practice Address - Phone:410-651-9852
Practice Address - Fax:410-651-1279
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD131541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
239603OtherANTHEM
054635OtherJHHC
7125933OtherAETNA
E1540040OtherCAREFIRST BLUE CHOICE
239603OtherANTHEM
MDS118P166Medicare PIN