Provider Demographics
NPI:1558092932
Name:JOANNE TERRY SWANSON, LICSW, LCSW
Entity Type:Organization
Organization Name:JOANNE TERRY SWANSON, LICSW, LCSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICIAN, OWNER/MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOANNE
Authorized Official - Middle Name:TERRY
Authorized Official - Last Name:SWANSON
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW, LCSW
Authorized Official - Phone:413-687-4057
Mailing Address - Street 1:133 WATERFORD LN
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-6905
Mailing Address - Country:US
Mailing Address - Phone:413-687-4057
Mailing Address - Fax:
Practice Address - Street 1:133 WATERFORD LN
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-6905
Practice Address - Country:US
Practice Address - Phone:413-687-4057
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-17
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty