Provider Demographics
NPI:1336450329
Name:SWANN, MARIA (PHD)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:SWANN
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 1:1427 N LA BREA AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90028-7505
Mailing Address - Country:US
Mailing Address - Phone:323-851-4577
Mailing Address - Fax:323-878-0440
Practice Address - Street 1:1427 N LA BREA AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90028-7505
Practice Address - Country:US
Practice Address - Phone:323-851-4577
Practice Address - Fax:323-878-0440
Is Sole Proprietor?:No
Enumeration Date:2010-06-24
Last Update Date:2015-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11879103T00000X
CASP 346235Z00000X
CAPSY 11879103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist