Provider Demographics
NPI:1578922779
Name:SWAFFORD, AMBRIJE
Entity Type:Individual
Prefix:
First Name:AMBRIJE
Middle Name:
Last Name:SWAFFORD
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 1:1770 E 118TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90059-2518
Mailing Address - Country:US
Mailing Address - Phone:323-249-2950
Mailing Address - Fax:323-249-2970
Practice Address - Street 1:1770 E 118TH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90059-2518
Practice Address - Country:US
Practice Address - Phone:323-249-2950
Practice Address - Fax:323-249-2970
Is Sole Proprietor?:No
Enumeration Date:2016-02-16
Last Update Date:2022-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA694731041C0700X
CA1075161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical