Healthcare Provider Details

I. General information

NPI: 1578767208
Provider Name (Legal Business Name): KAREN SWOBODA M.S, B.C.B.A
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 01/24/2025
Certification Date: 01/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1219 VERMONT AVE
LYNN HAVEN FL
32444-2162
US

IV. Provider business mailing address

PO BOX 40
LYNN HAVEN FL
32444-0040
US

V. Phone/Fax

Practice location:
  • Phone: 850-814-8941
  • Fax: 850-252-6027
Mailing address:
  • Phone: 850-814-8941
  • Fax: 850-252-6027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number553
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number1-05-2631
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number2022-089
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: