Provider Demographics
NPI:1114398120
Name:SWEENEY, ELLEN (MA, LPC LCADC)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:SWEENEY
Suffix:
Gender:F
Credentials:MA, LPC LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1112 LARCHMONT ST
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08757-1806
Mailing Address - Country:US
Mailing Address - Phone:732-814-9401
Mailing Address - Fax:
Practice Address - Street 1:1350 CAMPUS PKWY STE 101
Practice Address - Street 2:
Practice Address - City:WALL TOWNSHIP
Practice Address - State:NJ
Practice Address - Zip Code:07753-6821
Practice Address - Country:US
Practice Address - Phone:732-924-5589
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-16
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00218000101YA0400X
NJ37PC00531100101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)