Provider Demographics
NPI:1427103233
Name:SWENSON, REGGIE BRUCE (LCSW)
Entity type:Individual
Prefix:MR
First Name:REGGIE
Middle Name:BRUCE
Last Name:SWENSON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 S AIRMONT RD
Mailing Address - Street 2:
Mailing Address - City:SUFFERN
Mailing Address - State:NY
Mailing Address - Zip Code:10901-7134
Mailing Address - Country:US
Mailing Address - Phone:845-357-3944
Mailing Address - Fax:
Practice Address - Street 1:3 CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:SUFFERN
Practice Address - State:NY
Practice Address - Zip Code:10901-6301
Practice Address - Country:US
Practice Address - Phone:845-368-5222
Practice Address - Fax:845-368-5322
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR017358-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical