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NPI Code Detail

MEDICARE: JACYNTHIA SWANN

MEDICARE: JACYNTHIA SWANN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TM1800XIntellectual & Developmental Disabilities PsychologistNC
2172V00000XCommunity Health WorkerNC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1447529466
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACYNTHIA SWANN
Provider Business Mailing Address
First Line : 405 MORSON ST STE A
Second Line :
City : RALEIGH
State : NC
Zip : 27601-1559
Country : US
Telephone Number : 919-607-2044
Fax Number :
Provider Business Practice Location Address
First Line : 405 MORSON ST STE A
Second Line :
City : RALEIGH
State : NC
Zip : 27601-1559
Country : US
Telephone Number : 919-607-2044
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/20/2011
Last Update Date : 12/20/2011

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Directions to “ JACYNTHIA SWANN ” Practice Location

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