Provider Demographics
NPI:1790276236
Name:SWANTKOSKI, CAROLINE L (LMFT)
Entity Type:Individual
Prefix:
First Name:CAROLINE
Middle Name:L
Last Name:SWANTKOSKI
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 BEAR TAVERN RD
Mailing Address - Street 2:
Mailing Address - City:EWING
Mailing Address - State:NJ
Mailing Address - Zip Code:08628-1011
Mailing Address - Country:US
Mailing Address - Phone:908-581-5558
Mailing Address - Fax:
Practice Address - Street 1:225 S 69TH ST
Practice Address - Street 2:
Practice Address - City:UPPER DARBY
Practice Address - State:PA
Practice Address - Zip Code:19082-4212
Practice Address - Country:US
Practice Address - Phone:610-352-8943
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-21
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMF001002106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist