Provider Demographics
NPI:1316256357
Name:SWAN, SUSAN AILLEN
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:AILLEN
Last Name:SWAN
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:SUSAN
Other - Middle Name:AILLEN
Other - Last Name:DALY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:1 WASHINGTON ST
Mailing Address - Street 2:MILL RIVER PROFESSIONAL BUILDING
Mailing Address - City:TAUNTON
Mailing Address - State:MA
Mailing Address - Zip Code:02780-3960
Mailing Address - Country:US
Mailing Address - Phone:508-828-9112
Mailing Address - Fax:508-828-9146
Practice Address - Street 1:1 WASHINGTON ST
Practice Address - Street 2:MILL RIVER PROFESSIONAL BUILDING
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780-3960
Practice Address - Country:US
Practice Address - Phone:508-828-9112
Practice Address - Fax:508-828-9146
Is Sole Proprietor?:No
Enumeration Date:2010-09-24
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA344274101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool