Provider Demographics
NPI:1982636981
Name:SWARTZ, ILENE (MSW LICSW)
Entity Type:Individual
Prefix:MS
First Name:ILENE
Middle Name:
Last Name:SWARTZ
Suffix:
Gender:F
Credentials:MSW LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 ALLEN AVE
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01902-2735
Mailing Address - Country:US
Mailing Address - Phone:617-797-6528
Mailing Address - Fax:781-477-3930
Practice Address - Street 1:583 CHESTNUT ST
Practice Address - Street 2:SUITE 12
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01904-2600
Practice Address - Country:US
Practice Address - Phone:617-797-6528
Practice Address - Fax:781-477-3930
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2013-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1016635104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1891685Medicaid
MA1891685Medicaid