Provider Demographics
NPI:1649500380
Name:SWETNAM, JOSHUA ERIC (LCSW)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:ERIC
Last Name:SWETNAM
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 1:161 WEISSER AVE
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40206-2761
Mailing Address - Country:US
Mailing Address - Phone:502-494-1669
Mailing Address - Fax:
Practice Address - Street 1:161 WEISSER AVE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40206-2761
Practice Address - Country:US
Practice Address - Phone:502-494-1669
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-31
Last Update Date:2016-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY20831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY12696055OtherCAQH
KY7100287140Medicaid