Provider Demographics
NPI:1023727955
Name:SWARTZ, ROGER B (GRADUATE DIPLOMA)
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:B
Last Name:SWARTZ
Suffix:
Gender:M
Credentials:GRADUATE DIPLOMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 WORTHEN RD # B1
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-4831
Mailing Address - Country:US
Mailing Address - Phone:215-280-4756
Mailing Address - Fax:
Practice Address - Street 1:34 WORTHEN RD # B1
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02421-4831
Practice Address - Country:US
Practice Address - Phone:215-280-4756
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-18
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty