MEDICARE: MS. EDYTHE JOYCE SWIDLER MFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	MFC 30135	CA

General Provider Information

NPI Number	:	1013923077
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. EDYTHE JOYCE SWIDLER MFT

Provider Business Mailing Address
First Line	:	8708 LAGUNA STAR DR
Second Line	:
City	:	ELK GROVE
State	:	CA
Zip	:	95758-6316
Country	:	US
Telephone Number	:	916-548-1834
Fax Number	:

Provider Business Practice Location Address
First Line	:	7958 CARMENCITA AVE
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95829-9444
Country	:	US
Telephone Number	:	916-548-1834
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	07/27/2014

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