Provider Demographics
NPI:1063582377
Name:SWOBODA, MARY (MSW)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:
Last Name:SWOBODA
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:FRANCES
Other - Last Name:SWOBODA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW, LMHP
Mailing Address - Street 1:1018 S 35TH ST
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-3460
Mailing Address - Country:US
Mailing Address - Phone:402-450-3614
Mailing Address - Fax:402-489-3666
Practice Address - Street 1:3801 UNION DR
Practice Address - Street 2:SUITE 206
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-6652
Practice Address - Country:US
Practice Address - Phone:402-489-2218
Practice Address - Fax:402-489-3666
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2771041C0700X
NE717101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE275925Medicare ID - Type UnspecifiedLMHP