Healthcare Provider Details

I. General information

NPI: 1891879722
Provider Name (Legal Business Name): SUZANNE CARMEL SWANSON MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/25/2006
Last Update Date: 07/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5430 N PALM #108 ST JOSEPH COUNSELING CENTER
FRESNO CA
93704
US

IV. Provider business mailing address

5430 N PALM #108 ST JOSEPH COUNSELING CENTER
FRESNO CA
93704
US

V. Phone/Fax

Practice location:
  • Phone: 559-438-1200
  • Fax: 559-438-1413
Mailing address:
  • Phone: 559-438-1200
  • Fax: 559-438-1413

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS 10586
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC 19186
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: