Provider Demographics
NPI:1063650497
Name:SWANSON, MARY-LYNN RUTH (INTERN)
Entity Type:Individual
Prefix:
First Name:MARY-LYNN
Middle Name:RUTH
Last Name:SWANSON
Suffix:
Gender:F
Credentials:INTERN
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 424
Mailing Address - Street 2:
Mailing Address - City:SOUTH YARMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02664-0424
Mailing Address - Country:US
Mailing Address - Phone:508-815-5111
Mailing Address - Fax:
Practice Address - Street 1:30 HIGGINS CROWELL RD
Practice Address - Street 2:STE 4
Practice Address - City:WEST YARMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02673-3444
Practice Address - Country:US
Practice Address - Phone:508-240-7964
Practice Address - Fax:508-778-8581
Is Sole Proprietor?:No
Enumeration Date:2009-01-22
Last Update Date:2017-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1169221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical