MEDICARE: MARISA SWAIN

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	106H00000X	Marriage & Family Therapist	125330	CA

General Provider Information

NPI Number	:	1922553650
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARISA SWAIN

Provider Business Mailing Address
First Line	:	133 LAS PALMAS AVE
Second Line	:
City	:	VALLEJO
State	:	CA
Zip	:	94589-2644
Country	:	US
Telephone Number	:	510-556-4544
Fax Number	:

Provider Business Practice Location Address
First Line	:	133 LAS PALMAS AVE
Second Line	:
City	:	VALLEJO
State	:	CA
Zip	:	94589-2644
Country	:	US
Telephone Number	:	510-556-4544
Fax Number	:

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

Provider Enumeration Date	:	08/23/2016
Last Update Date	:	06/26/2023

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Directions to “ MARISA SWAIN ” Practice Location

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