Provider Demographics
NPI:1215126404
Name:DR. ANNETTE SWAIN, A PSYCHOLOGICAL CORP
Entity type:Organization
Organization Name:DR. ANNETTE SWAIN, A PSYCHOLOGICAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:M
Authorized Official - Last Name:SWAIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:818-385-0913
Mailing Address - Street 1:15928 VENTURA BLVD STE 231
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-4409
Mailing Address - Country:US
Mailing Address - Phone:818-385-0913
Mailing Address - Fax:818-385-1746
Practice Address - Street 1:15928 VENTURA BLVD STE 231
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-4409
Practice Address - Country:US
Practice Address - Phone:818-385-0913
Practice Address - Fax:818-385-1746
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-24
Last Update Date:2008-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16330103G00000X, 103TA0700X, 103TB0200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & AgingGroup - Multi-Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW21578OtherMEDICARE PTAN