Provider Demographics
NPI:1851898746
Name:SWANSON, CLARE BURKE
Entity Type:Individual
Prefix:
First Name:CLARE
Middle Name:BURKE
Last Name:SWANSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CLARE
Other - Middle Name:STOREY
Other - Last Name:BURKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:399 E PUTNAM AVE STE 2
Mailing Address - Street 2:
Mailing Address - City:COS COB
Mailing Address - State:CT
Mailing Address - Zip Code:06807-2558
Mailing Address - Country:US
Mailing Address - Phone:203-541-1154
Mailing Address - Fax:
Practice Address - Street 1:399 E PUTNAM AVE STE 2
Practice Address - Street 2:
Practice Address - City:COS COB
Practice Address - State:CT
Practice Address - Zip Code:06807-2558
Practice Address - Country:US
Practice Address - Phone:203-541-1154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-09
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT723242084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry