Provider Demographics
NPI:1144888595
Name:SWANK, LUCY HARVEY
Entity type:Individual
Prefix:MISS
First Name:LUCY
Middle Name:HARVEY
Last Name:SWANK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:829 OCEAN PARK BLVD APT 1
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-3947
Mailing Address - Country:US
Mailing Address - Phone:914-582-3553
Mailing Address - Fax:
Practice Address - Street 1:2001 SOUTH BARRINGTON AVENUE LOS ANGELES, CA 90025
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-9002
Practice Address - Country:US
Practice Address - Phone:914-582-3553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-31
Last Update Date:2019-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA774631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical