Healthcare Provider Details

I. General information

NPI: 1104830256
Provider Name (Legal Business Name): GWEN SCHWIMMER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 11/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6615 E PACIFIC COAST HWY SUITE 115
LONG BEACH CA
90803-4211
US

IV. Provider business mailing address

334 NEWPORT AVE APT 4
LONG BEACH CA
90814-2675
US

V. Phone/Fax

Practice location:
  • Phone: 646-280-5121
  • Fax:
Mailing address:
  • Phone: 646-280-5121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR035447-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number23240
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: