Provider Demographics
NPI:1336176239
Name:SWAIN, ANNETTE M (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANNETTE
Middle Name:M
Last Name:SWAIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15928 VENTURA BLVD
Mailing Address - Street 2:#231
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-4401
Mailing Address - Country:US
Mailing Address - Phone:818-385-0913
Mailing Address - Fax:818-385-1746
Practice Address - Street 1:15928 VENTURA BLVD
Practice Address - Street 2:#231
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-4401
Practice Address - Country:US
Practice Address - Phone:818-385-0913
Practice Address - Fax:818-385-1746
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16330103G00000X, 103TA0700X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP16330Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER