Provider Demographics
NPI:1639271687
Name:SWANSON, GERALD C (LCSW)
Entity Type:Individual
Prefix:MR
First Name:GERALD
Middle Name:C
Last Name:SWANSON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:MR
Other - First Name:GERRY
Other - Middle Name:C
Other - Last Name:SWANSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:4308 CARLISLE BLVD NE STE 210
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-4856
Mailing Address - Country:US
Mailing Address - Phone:505-247-1921
Mailing Address - Fax:505-247-1020
Practice Address - Street 1:4308 CARLISLE BLVD NE STE 210
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-4856
Practice Address - Country:US
Practice Address - Phone:505-247-1921
Practice Address - Fax:505-247-1020
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-01951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1936916871OtherCNN 1ST HEALTH
NMNM00R60POtherBCBS
411232OtherONE HEALTH PLAN
2014445OtherCIGNA
NMZ2266Medicaid
NM000Z2266Medicaid
518055295OtherPACIFICARE
198950OtherMHN
125990OtherVALUE OPTIONS
32243OtherLOVELACE HP
94167OtherUNITED HEALTH UBH