Provider Demographics
NPI:1588863633
Name:SWIM, SUSAN E (PHD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:E
Last Name:SWIM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9039 ALCOTT ST APT 9
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-3343
Mailing Address - Country:US
Mailing Address - Phone:626-487-9305
Mailing Address - Fax:
Practice Address - Street 1:9633 BADEN AVE # 9
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:CA
Practice Address - Zip Code:91311-2622
Practice Address - Country:US
Practice Address - Phone:626-487-9305
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-17
Last Update Date:2019-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40480106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMF404800Medicaid