Provider Demographics
NPI:1326188673
Name:SWANSON, STEVEN CLIFFORD (PHD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:CLIFFORD
Last Name:SWANSON
Suffix:
Gender:M
Credentials:PHD
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 25926
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93729-5926
Mailing Address - Country:US
Mailing Address - Phone:559-434-4344
Mailing Address - Fax:559-434-4344
Practice Address - Street 1:4781 E GETTYSBURG AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-1814
Practice Address - Country:US
Practice Address - Phone:559-434-4344
Practice Address - Fax:559-434-4344
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13948103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY139481Medicaid
CAPSY139481Medicaid