Provider Demographics
NPI:1891165361
Name:SWIFT, CAMPBELL MACKIE (LCSW)
Entity Type:Individual
Prefix:MR
First Name:CAMPBELL
Middle Name:MACKIE
Last Name:SWIFT
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 1:36 MILLER STILE RD
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-5423
Mailing Address - Country:US
Mailing Address - Phone:617-302-3487
Mailing Address - Fax:
Practice Address - Street 1:36 MILLER STILE RD
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-5423
Practice Address - Country:US
Practice Address - Phone:908-578-0949
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-28
Last Update Date:2022-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0421605281041C0700X
MA2259801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1801916176Medicaid