Provider Demographics
NPI:1811998347
Name:SWENSON, CHARLOTTE MCCAFFERTY (PHD)
Entity type:Individual
Prefix:MRS
First Name:CHARLOTTE
Middle Name:MCCAFFERTY
Last Name:SWENSON
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 1:3411 SILVERSIDE RD
Mailing Address - Street 2:WELDIN BLDG - 109
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19810-4812
Mailing Address - Country:US
Mailing Address - Phone:302-743-3843
Mailing Address - Fax:302-529-5763
Practice Address - Street 1:3411 SILVERSIDE RD
Practice Address - Street 2:WELDIN BLDG - 109
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19810-4812
Practice Address - Country:US
Practice Address - Phone:302-743-3843
Practice Address - Fax:302-529-5763
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-09
Last Update Date:2015-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEB1-0000190103T00000X
PAPS-0042726103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1878454OtherFIRST HEALTH
DEPVPB43922OtherAPS
DE233395OtherCOMPSYCH
DE62006383OtherRR MEDICARE
DE1878454OtherFIRST HEALTH
DE62006383OtherRR MEDICARE