MEDICARE: COURTNEY ALEXANDRA SWATTA M.A., 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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1750487443
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COURTNEY ALEXANDRA SWATTA M.A., PSY D.

Provider Business Mailing Address
First Line	:	21 FONTANA CT
Second Line	:
City	:	NOVATO
State	:	CA
Zip	:	94945-1833
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	161 MITCHELL BLVD
Second Line	:	SUITE 101
City	:	SAN RAFAEL
State	:	CA
Zip	:	94903-2068
Country	:	US
Telephone Number	:	415-499-7594
Fax Number	:

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

Provider Enumeration Date	:	09/16/2006
Last Update Date	:	07/08/2007

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