Provider Demographics
NPI:1114142890
Name:RIVERA-SWANK, MARGARITA (MFC)
Entity Type:Individual
Prefix:
First Name:MARGARITA
Middle Name:
Last Name:RIVERA-SWANK
Suffix:
Gender:F
Credentials:MFC
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 308
Mailing Address - Street 2:
Mailing Address - City:WATSONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95077-0308
Mailing Address - Country:US
Mailing Address - Phone:831-728-9970
Mailing Address - Fax:
Practice Address - Street 1:11 ALEXANDER ST STE D
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-4626
Practice Address - Country:US
Practice Address - Phone:831-728-9970
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC27553106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMFC27553OtherLICENSE NUMBER