Provider Demographics
NPI:1811048002
Name:SWIFT, JONATHAN WETHERBY (LCSW, PHD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:WETHERBY
Last Name:SWIFT
Suffix:
Gender:M
Credentials:LCSW, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:588 BOSTON POST RD
Mailing Address - Street 2:SUITE EAST
Mailing Address - City:MADISON
Mailing Address - State:CT
Mailing Address - Zip Code:06443-3042
Mailing Address - Country:US
Mailing Address - Phone:203-245-0062
Mailing Address - Fax:203-245-9446
Practice Address - Street 1:588 BOSTON POST RD
Practice Address - Street 2:SUITE EAST
Practice Address - City:MADISON
Practice Address - State:CT
Practice Address - Zip Code:06443-3042
Practice Address - Country:US
Practice Address - Phone:203-245-0062
Practice Address - Fax:203-245-9446
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT18211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical