Provider Demographics
NPI:1629246897
Name:JOSEPH SWOBODA PHD, LLC
Entity Type:Organization
Organization Name:JOSEPH SWOBODA PHD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:SWOBODA
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:402-432-9789
Mailing Address - Street 1:3801 UNION DR
Mailing Address - Street 2:STE 206
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-6652
Mailing Address - Country:US
Mailing Address - Phone:402-489-2218
Mailing Address - Fax:402-489-3666
Practice Address - Street 1:3801 UNION DR
Practice Address - Street 2:STE 206
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68516-6652
Practice Address - Country:US
Practice Address - Phone:402-489-2218
Practice Address - Fax:402-489-3666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-11
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE261103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025286200Medicaid
NE1063425171OtherPHD NPI
NE1063425171OtherPHD NPI