Basic Information
| Provider Information | |||||||||
| NPI: | 1295905784 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SWAIM | ||||||||
| FirstName: | BURTON | ||||||||
| MiddleName: | MENROW | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 407 PASEO PACIFICA | ||||||||
| Address2: | |||||||||
| City: | ENCINITAS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920243645 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6196616500 | ||||||||
| FaxNumber: | 7606717585 | ||||||||
| Practice Location | |||||||||
| Address1: | 480 ALTA RD | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921790001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6196616500 | ||||||||
| FaxNumber: | 6196717585 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/11/2008 | ||||||||
| LastUpdateDate: | 03/11/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | LCS 2658 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.