Provider Demographics
NPI:1265636989
Name:SWAN, GEORGINA FLORENCE (LMFT)
Entity Type:Individual
Prefix:
First Name:GEORGINA
Middle Name:FLORENCE
Last Name:SWAN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:
Other - Last Name:SWAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:494 CARR AVE
Mailing Address - Street 2:
Mailing Address - City:AROMAS
Mailing Address - State:CA
Mailing Address - Zip Code:95004-9537
Mailing Address - Country:US
Mailing Address - Phone:831-726-3960
Mailing Address - Fax:
Practice Address - Street 1:420 MAIN ST
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076
Practice Address - Country:US
Practice Address - Phone:831-726-3960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-14
Last Update Date:2018-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 27552106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist