Provider Demographics
NPI:1730369380
Name:SWAN, AMY C (PSY D)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:C
Last Name:SWAN
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:918 NE 26TH AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33304-3607
Mailing Address - Country:US
Mailing Address - Phone:954-567-8000
Mailing Address - Fax:954-567-0929
Practice Address - Street 1:918 NE 26TH AVE
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33304-3607
Practice Address - Country:US
Practice Address - Phone:954-567-8000
Practice Address - Fax:954-567-0929
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-13
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY5908103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic