Provider Demographics
NPI:1831219120
Name:SWANN, SALLY L (LCSW)
Entity type:Individual
Prefix:MS
First Name:SALLY
Middle Name:L
Last Name:SWANN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11336 LANDALE ST
Mailing Address - Street 2:#3
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91602-2037
Mailing Address - Country:US
Mailing Address - Phone:818-761-5370
Mailing Address - Fax:
Practice Address - Street 1:12456 VENTURA BLVD
Practice Address - Street 2:STE. 2A
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-2480
Practice Address - Country:US
Practice Address - Phone:818-761-0525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS#177151041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical