Provider Demographics
NPI:1114160512
Name:SWAIN, CONNIE ATHENA
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:ATHENA
Last Name:SWAIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:995 MARKET ST
Mailing Address - Street 2:FLOOR 5
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-1702
Mailing Address - Country:US
Mailing Address - Phone:415-644-0507
Mailing Address - Fax:415-644-0380
Practice Address - Street 1:995 MARKET ST
Practice Address - Street 2:FLOOR 5
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-1702
Practice Address - Country:US
Practice Address - Phone:415-644-0507
Practice Address - Fax:415-644-0380
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-14
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor