Provider Demographics
NPI:1821039744
Name:SWAN, DAINETT (LCSW #53011)
Entity Type:Individual
Prefix:MRS
First Name:DAINETT
Middle Name:
Last Name:SWAN
Suffix:
Gender:F
Credentials:LCSW #53011
Other - Prefix:MRS
Other - First Name:DAINETT
Other - Middle Name:
Other - Last Name:SWAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW #27352
Mailing Address - Street 1:3750 COMMERCIAL AVE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78221-3117
Mailing Address - Country:US
Mailing Address - Phone:210-334-3700
Mailing Address - Fax:210-922-0162
Practice Address - Street 1:5542 WALZEM RD
Practice Address - Street 2:
Practice Address - City:WINDCREST
Practice Address - State:TX
Practice Address - Zip Code:78218-2103
Practice Address - Country:US
Practice Address - Phone:210-637-2450
Practice Address - Fax:210-590-1380
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-10
Last Update Date:2014-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW #273521041C0700X
TX530111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID002648300Medicaid
ID7644813OtherAETNA
ID000010155033OtherBLUE SHIELD
IDL5906OtherBLUE CROSS
IDL5906OtherBLUE CROSS