Provider Demographics
NPI:1528399086
Name:SWANSON, MELINDA MCQUISTON (LCSW)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:MCQUISTON
Last Name:SWANSON
Suffix:
Gender:F
Credentials:LCSW
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 6041
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95150-6041
Mailing Address - Country:US
Mailing Address - Phone:408-279-2411
Mailing Address - Fax:
Practice Address - Street 1:248 BLOSSOM HILL ROAD
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-4420
Practice Address - Country:US
Practice Address - Phone:408-279-2411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-22
Last Update Date:2016-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 95211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical