1821039744 NPI number — MRS. DAINETT SWAN LCSW #53011

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821039744 NPI number — MRS. DAINETT SWAN LCSW #53011

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SWAN
Provider First Name:
DAINETT
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW #53011
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SWAN
Provider Other First Name:
DAINETT
Provider Other Middle Name:
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW #27352
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1821039744
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/04/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3750 COMMERCIAL AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78221-3117
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-334-3700
Provider Business Mailing Address Fax Number:
210-922-0162

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5542 WALZEM RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINDCREST
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78218-2103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-637-2450
Provider Business Practice Location Address Fax Number:
210-590-1380
Provider Enumeration Date:
06/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  LCSW #27352 , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 1041C0700X , with the licence number: 53011 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 002648300 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7644813 . This is a "AETNA" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: 000010155033 . This is a "BLUE SHIELD" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".
  • Identifier: L5906 . This is a "BLUE CROSS" identifier , issued by the state of ( ID ) . This identifiers is of the category "OTHER".




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