Provider Demographics
NPI:1811773740
Name:SWAIN, VICTORIA (LICSW)
Entity type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:SWAIN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4003 WHITE BEAR AVE N
Mailing Address - Street 2:
Mailing Address - City:WHITE BEAR LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:55110-4304
Mailing Address - Country:US
Mailing Address - Phone:763-258-9955
Mailing Address - Fax:
Practice Address - Street 1:236 CLIFTON AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403-3466
Practice Address - Country:US
Practice Address - Phone:651-243-4250
Practice Address - Fax:612-464-7229
Is Sole Proprietor?:No
Enumeration Date:2023-09-06
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN29464103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst