Healthcare Provider Details

I. General information

NPI: 1811998347
Provider Name (Legal Business Name): CHARLOTTE MCCAFFERTY SWENSON PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 08/31/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3411 SILVERSIDE RD WELDIN BLDG - 109
WILMINGTON DE
19810-4812
US

IV. Provider business mailing address

3411 SILVERSIDE RD WELDIN BLDG - 109
WILMINGTON DE
19810-4812
US

V. Phone/Fax

Practice location:
  • Phone: 302-743-3843
  • Fax: 302-529-5763
Mailing address:
  • Phone: 302-743-3843
  • Fax: 302-529-5763

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberB1-0000190
License Number StateDE
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS-0042726
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: