Healthcare Provider Details

I. General information

NPI: 1215126404
Provider Name (Legal Business Name): DR. ANNETTE SWAIN, A PSYCHOLOGICAL CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2007
Last Update Date: 02/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15928 VENTURA BLVD STE 231
ENCINO CA
91436-4409
US

IV. Provider business mailing address

15928 VENTURA BLVD STE 231
ENCINO CA
91436-4409
US

V. Phone/Fax

Practice location:
  • Phone: 818-385-0913
  • Fax: 818-385-1746
Mailing address:
  • Phone: 818-385-0913
  • Fax: 818-385-1746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number16330
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number16330
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number16330
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number16330
License Number StateCA

VIII. Authorized Official

Name: DR. ANNETTE M SWAIN
Title or Position: PSYCHOLOGIST/OWNER
Credential: PH.D.
Phone: 818-385-0913