Provider Demographics
NPI:1932962792
Name:SWINTON-JACKSON, CYNTHIA E (PHD, LPC)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:E
Last Name:SWINTON-JACKSON
Suffix:
Gender:F
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 NYACK AVE
Mailing Address - Street 2:
Mailing Address - City:LANSDOWNE
Mailing Address - State:PA
Mailing Address - Zip Code:19050-2809
Mailing Address - Country:US
Mailing Address - Phone:215-422-2257
Mailing Address - Fax:
Practice Address - Street 1:1989 N 63RD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19151-2693
Practice Address - Country:US
Practice Address - Phone:610-639-1729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-05
Last Update Date:2024-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC015374101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional