Provider Demographics
NPI:1750098737
Name:EMOTIONAL & BEHAVIORAL HEALTH PSYCHOLOGY SWISTUN PHD INC
Entity type:Organization
Organization Name:EMOTIONAL & BEHAVIORAL HEALTH PSYCHOLOGY SWISTUN PHD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DOMINIKA
Authorized Official - Middle Name:J
Authorized Official - Last Name:SWISTUN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:312-375-1827
Mailing Address - Street 1:9850 GENESEE AVE STE 130
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1206
Mailing Address - Country:US
Mailing Address - Phone:312-375-1827
Mailing Address - Fax:
Practice Address - Street 1:9850 GENESEE AVE STE 130
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1206
Practice Address - Country:US
Practice Address - Phone:312-375-1827
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-31
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty