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General NPI Number Information
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NPI Number | 1477154052
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Entity Type | Individual
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Provider Name | MR. MARK T SWANSON
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Gender | Male
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Dates
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Enumeration Date | 11/02/2020
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Last Update Date | 10/15/2024
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Provider Practice Location Address
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Address Line | 1500 PALMA DR FL 2
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City | VENTURA
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State | CA
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Zip | 93003-6451
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Country | US
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Telephone | 626-344-9409
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Fax |
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Provider Business Mailing Address
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Address Line | 1001 FREMONT AVE # 1382
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City | SOUTH PASADENA
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State | CA
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Zip | 91031-7001
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Country | US
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Telephone | 626-253-5494
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | 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 | 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 #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 116015
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License Number State | CA
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