Provider Demographics
NPI:1467411272
Name:SWENSON-ABRAHAM, PATTI SUE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:PATTI
Middle Name:SUE
Last Name:SWENSON-ABRAHAM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2611 EDGEWATER DR
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-2308
Mailing Address - Country:US
Mailing Address - Phone:850-217-8482
Mailing Address - Fax:
Practice Address - Street 1:222 GOVERNMENT AVE
Practice Address - Street 2:SUITE A
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-1868
Practice Address - Country:US
Practice Address - Phone:850-678-1846
Practice Address - Fax:850-678-1853
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL72781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical