Provider Demographics
NPI:1972675585
Name:SWEDBERG, BRIAN C (LCSW)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:C
Last Name:SWEDBERG
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 1:220 COMMONS WAY
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-6427
Mailing Address - Country:US
Mailing Address - Phone:732-244-3311
Mailing Address - Fax:732-244-5742
Practice Address - Street 1:220 COMMONS WAY
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-6427
Practice Address - Country:US
Practice Address - Phone:732-244-3311
Practice Address - Fax:732-244-5742
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC005231001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ837856Medicare ID - Type UnspecifiedSW