Provider Demographics
NPI:1912035007
Name:SWENSON, VICTORIA SUE (MFC 44850)
Entity Type:Individual
Prefix:MS
First Name:VICTORIA
Middle Name:SUE
Last Name:SWENSON
Suffix:
Gender:F
Credentials:MFC 44850
Other - Prefix:
Other - First Name:VICTORIA
Other - Middle Name:SUE
Other - Last Name:OSBORNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2676 YERBA CLIFF CT
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95121-2904
Mailing Address - Country:US
Mailing Address - Phone:408-270-1609
Mailing Address - Fax:
Practice Address - Street 1:315 LOS GATOS SARATOGA RD
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95030-5310
Practice Address - Country:US
Practice Address - Phone:408-375-7320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-01
Last Update Date:2007-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 44850106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist