Provider Demographics
NPI:1124663794
Name:SWANSTROM, DEBORAH ANN (LCSW-C)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:ANN
Last Name:SWANSTROM
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13313 RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3617
Mailing Address - Country:US
Mailing Address - Phone:301-938-2450
Mailing Address - Fax:
Practice Address - Street 1:VESTA, INC.
Practice Address - Street 2:20410 OBSERVATION DRIVE SUITE 108
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20876-4000
Practice Address - Country:US
Practice Address - Phone:240-296-5848
Practice Address - Fax:301-528-4315
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-07
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD25305104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker