Provider Demographics
NPI:1841463544
Name:SWANN, BEVERLY (MA, LMFT)
Entity type:Individual
Prefix:
First Name:BEVERLY
Middle Name:
Last Name:SWANN
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1985 BONIFACIO ST STE 100
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-2264
Mailing Address - Country:US
Mailing Address - Phone:925-705-7036
Mailing Address - Fax:925-954-7489
Practice Address - Street 1:1985 BONIFACIO ST STE 100
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520
Practice Address - Country:US
Practice Address - Phone:925-705-7036
Practice Address - Fax:925-954-7489
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-02
Last Update Date:2018-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC-47971106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist