Provider Demographics
NPI:1083750350
Name:SWANSON, DAVID GORDON (MA)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:GORDON
Last Name:SWANSON
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 WALL ST
Mailing Address - Street 2:APT. 4
Mailing Address - City:GLOUCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01930-3047
Mailing Address - Country:US
Mailing Address - Phone:978-283-7198
Mailing Address - Fax:978-281-7793
Practice Address - Street 1:33 COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:GLOUCESTER
Practice Address - State:MA
Practice Address - Zip Code:01930-5040
Practice Address - Country:US
Practice Address - Phone:978-283-7198
Practice Address - Fax:978-281-7793
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor