Healthcare Provider Details

I. General information

NPI: 1093826299
Provider Name (Legal Business Name): BENJAMIN WILLSON SWAIN LICSW, ICADC,CADC II
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 10/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 W ST NE
WASHINGTON DC
20002-1241
US

IV. Provider business mailing address

9639 OXBRIDGE WAY
BOWIE MD
20721-3035
US

V. Phone/Fax

Practice location:
  • Phone: 301-613-2750
  • Fax: 301-386-3521
Mailing address:
  • Phone: 301-613-2750
  • Fax: 301-386-3521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number10191-502
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC50078081
License Number StateDC
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number13207
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: