MEDICARE: SWAN EXPRESSIVE THERAPIES

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
1	101YP2500X	Professional Counselor	LC 1896	MD

General Provider Information

NPI Number	:	1720271539
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SWAN EXPRESSIVE THERAPIES

Provider Business Mailing Address
First Line	:	260 GATEWAY DR
Second Line	:	BUILDING 1 SUITE 15B
City	:	BEL AIR
State	:	MD
Zip	:	21014-4268
Country	:	US
Telephone Number	:	443-326-5041
Fax Number	:

Provider Business Practice Location Address
First Line	:	6731 YOUNGSTOWN AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21222-1026
Country	:	US
Telephone Number	:	443-326-5041
Fax Number	:

Authorized Official
Title or Position	:	LICENSED CLINICAL PROF COUNSELOR
Name	:	MRS. MARA RITA SWAN
Credential	:	MA LCPC ATR-BC
Telephone Number	:	443-326-5041

Provider Enumeration Date	:	08/24/2007
Last Update Date	:	08/24/2007

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Directions to “SWAN EXPRESSIVE THERAPIES ” Practice Location

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