Provider Demographics
NPI:1013014711
Name:SWEARINGEN, ELIZABETH MARSHALL (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:MARSHALL
Last Name:SWEARINGEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1518 COFFEE RD
Mailing Address - Street 2:STE. C
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-3164
Mailing Address - Country:US
Mailing Address - Phone:209-577-4059
Mailing Address - Fax:209-572-2469
Practice Address - Street 1:1518 COFFEE RD
Practice Address - Street 2:STE. C
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-3164
Practice Address - Country:US
Practice Address - Phone:209-577-4059
Practice Address - Fax:209-572-2469
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY12174103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPL121740Medicare ID - Type Unspecified