Provider Demographics
NPI:1114018538
Name:SWEETSER, KATHERINE (MA, MFT)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:SWEETSER
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3160 TELEGRAPH RD STE 200
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-3250
Mailing Address - Country:US
Mailing Address - Phone:805-642-4611
Mailing Address - Fax:805-585-3241
Practice Address - Street 1:3160 TELEGRAPH RD STE 200
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-3250
Practice Address - Country:US
Practice Address - Phone:808-987-8285
Practice Address - Fax:808-331-1474
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT 37227106H00000X
HIMFT 83106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI51876401Medicaid