Provider Demographics
NPI:1447529599
Name:SWAYBILL, PENNY LYNN (MS)
Entity type:Individual
Prefix:MS
First Name:PENNY
Middle Name:LYNN
Last Name:SWAYBILL
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 MONTECITO AVE APT B
Mailing Address - Street 2:
Mailing Address - City:CORTE MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:94925-3501
Mailing Address - Country:US
Mailing Address - Phone:415-924-2593
Mailing Address - Fax:
Practice Address - Street 1:900 5TH AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-2959
Practice Address - Country:US
Practice Address - Phone:415-457-6964
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-19
Last Update Date:2011-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA237088977OtherBUCKELEW PROGRAMS