Provider Demographics
NPI:1306131420
Name:SWENSON, VICTOR HUGO III (LSW)
Entity type:Individual
Prefix:MR
First Name:VICTOR
Middle Name:HUGO
Last Name:SWENSON
Suffix:III
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 95
Mailing Address - Street 2:
Mailing Address - City:LIBERTY CORNER
Mailing Address - State:NJ
Mailing Address - Zip Code:07938-0095
Mailing Address - Country:US
Mailing Address - Phone:908-581-9306
Mailing Address - Fax:
Practice Address - Street 1:149 E 78TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10075-0405
Practice Address - Country:US
Practice Address - Phone:212-879-4900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-16
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL05478700104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker