Provider Demographics
NPI:1013122530
Name:SWANSON, LESLIE BETH (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:BETH
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 1:11983 TAMIAMI TRL N
Mailing Address - Street 2:SUITE #132
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34110-1603
Mailing Address - Country:US
Mailing Address - Phone:239-649-6010
Mailing Address - Fax:239-598-1417
Practice Address - Street 1:11983 TAMIAMI TRL N
Practice Address - Street 2:SUITE #132
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-1603
Practice Address - Country:US
Practice Address - Phone:239-649-6010
Practice Address - Fax:239-598-1417
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6313103TB0200X, 103TC0700X, 103TC2200X, 103TF0000X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic