Provider Demographics
NPI:1437632817
Name:SCHWAM, SUE ELLEN (LICSW)
Entity Type:Individual
Prefix:
First Name:SUE ELLEN
Middle Name:
Last Name:SCHWAM
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 BLUEBERRY POND DR
Mailing Address - Street 2:
Mailing Address - City:BREWSTER
Mailing Address - State:MA
Mailing Address - Zip Code:02631-2045
Mailing Address - Country:US
Mailing Address - Phone:508-367-6422
Mailing Address - Fax:
Practice Address - Street 1:401 BLUEBERRY POND DR
Practice Address - Street 2:
Practice Address - City:BREWSTER
Practice Address - State:MA
Practice Address - Zip Code:02631-2045
Practice Address - Country:US
Practice Address - Phone:508-367-6422
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-11
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1026591-SW-LICSW1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty