Provider Demographics
NPI:1336792100
Name:SWAN PSYCHOLOGICAL SERVICES, INC.
Entity Type:Organization
Organization Name:SWAN PSYCHOLOGICAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LIC. PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JUNE
Authorized Official - Middle Name:ANGELA
Authorized Official - Last Name:SWAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:909-463-9004
Mailing Address - Street 1:8333 E. FOOTHILL BLVD., SUITE 109
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730
Mailing Address - Country:US
Mailing Address - Phone:909-510-7643
Mailing Address - Fax:909-463-9004
Practice Address - Street 1:8333 E. FOOTHILL BLVD., SUITE 109
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730
Practice Address - Country:US
Practice Address - Phone:909-510-7643
Practice Address - Fax:909-463-9004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-22
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty