Provider Demographics
NPI:1295855468
Name:SWAN, JUNE ANGELA (PH D)
Entity Type:Individual
Prefix:DR
First Name:JUNE
Middle Name:ANGELA
Last Name:SWAN
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8333 E. FOOTHILL BLVD.
Mailing Address - Street 2:SUITE 109
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730
Mailing Address - Country:US
Mailing Address - Phone:909-510-7643
Mailing Address - Fax:909-463-9004
Practice Address - Street 1:8333 E. FOOTHILL BLVD.
Practice Address - Street 2:SUITE 109
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730
Practice Address - Country:US
Practice Address - Phone:909-510-7643
Practice Address - Fax:909-463-9004
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16138103T00000X
103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist