Provider Demographics
NPI:1457303596
Name:SWAIN, DAVID A (LICSW)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:A
Last Name:SWAIN
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 S ANGELL ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-5206
Mailing Address - Country:US
Mailing Address - Phone:401-632-4045
Mailing Address - Fax:401-632-4460
Practice Address - Street 1:35 S ANGELL ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-5206
Practice Address - Country:US
Practice Address - Phone:401-632-4045
Practice Address - Fax:401-632-4460
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2015-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW003901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI30329-7OtherBLUE SHIELD PROVIDER #
RI002224OtherBLUE CHIP PROVIDER #