Provider Demographics
NPI:1982851747
Name:SWANSON, KRISTIN SALDARELLI (PSYD)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:SALDARELLI
Last Name:SWANSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11150 SUNSET HILLS RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20190-5360
Mailing Address - Country:US
Mailing Address - Phone:914-772-1892
Mailing Address - Fax:
Practice Address - Street 1:11150 SUNSET HILLS RD
Practice Address - Street 2:SUITE 150
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20190-5360
Practice Address - Country:US
Practice Address - Phone:914-772-1892
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-24
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810004341103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical