Provider Demographics
NPI:1699812081
Name:SWANHART, MICHAEL ALBERT (LCSW)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ALBERT
Last Name:SWANHART
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2724 COLLEGE ST
Mailing Address - Street 2:SUITE 6
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32205-7493
Mailing Address - Country:US
Mailing Address - Phone:904-527-3167
Mailing Address - Fax:904-425-2134
Practice Address - Street 1:2724 COLLEGE ST
Practice Address - Street 2:SUITE 6
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32205-7493
Practice Address - Country:US
Practice Address - Phone:904-527-3167
Practice Address - Fax:904-425-2134
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW75351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL766661600Medicaid