MEDICARE: AMY C. SWAN PSY. D.

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	103TF0200X	Forensic Psychologist	PY5908	FL

General Provider Information

NPI Number	:	1730369380
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY C. SWAN PSY. D.

Provider Business Mailing Address
First Line	:	918 NE 26TH AVE
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33304-3607
Country	:	US
Telephone Number	:	954-567-8000
Fax Number	:	954-567-0929

Provider Business Practice Location Address
First Line	:	918 NE 26TH AVE
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33304-3607
Country	:	US
Telephone Number	:	954-567-8000
Fax Number	:	954-567-0929

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/13/2007
Last Update Date	:	11/13/2007

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