Provider Demographics
NPI:1548048788
Name:SWIG, GWYNDOLYN R
Entity type:Individual
Prefix:
First Name:GWYNDOLYN
Middle Name:R
Last Name:SWIG
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 1:501 MARIN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-4265
Mailing Address - Country:US
Mailing Address - Phone:805-990-2928
Mailing Address - Fax:
Practice Address - Street 1:501 MARIN ST STE 100
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-4265
Practice Address - Country:US
Practice Address - Phone:805-413-0350
Practice Address - Fax:805-413-0357
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-19
Last Update Date:2025-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA152138106H00000X
171M00000X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program