Provider Demographics
NPI:1881188845
Name:SWIGART, THEODORE EARL IV (PHD)
Entity Type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:EARL
Last Name:SWIGART
Suffix:IV
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10165 FOOTHILL BLVD STE 3
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-0341
Mailing Address - Country:US
Mailing Address - Phone:909-244-9593
Mailing Address - Fax:
Practice Address - Street 1:10165 FOOTHILL BLVD STE 3
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-0341
Practice Address - Country:US
Practice Address - Phone:909-244-9593
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-21
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY19842103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical