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General NPI Number Information
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NPI Number | 1467097980
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Entity Type | Organization
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Legal Business Name | SWANSON PSYCHOTHERAPEUTIC, LLC
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Dates
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Enumeration Date | 11/07/2019
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Last Update Date | 11/19/2019
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Provider Practice Location Address
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Address Line | 311 S CENTRAL AVE STE 104
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City | CANONSBURG
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State | PA
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Zip | 15317-1637
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Country | US
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Telephone | 412-737-6236
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Fax |
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Provider Business Mailing Address
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Address Line | 617 SETTER LN
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City | JEFFERSON HILLS
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State | PA
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Zip | 15025-3284
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Country | US
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Telephone | 412-737-6236
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Fax |
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Authorized Official
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Title or Position | PSYCHOTHERAPIST
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Name | DANIELLE SWANSON
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Credential | LCSW
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Telephone | 412-737-6236
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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