Provider Demographics
NPI:1942680111
Name:SWANBERG, SARAH W (LAC)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:W
Last Name:SWANBERG
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 ALMA ROCK RD
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06903-4209
Mailing Address - Country:US
Mailing Address - Phone:917-597-5734
Mailing Address - Fax:
Practice Address - Street 1:66 ALMA ROCK RD
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06903-4209
Practice Address - Country:US
Practice Address - Phone:917-597-5734
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-03
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT639171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist