Provider Demographics
NPI:1174633549
Name:SWEETBAUM, HARVEY ARNOLD (PHD)
Entity Type:Individual
Prefix:
First Name:HARVEY
Middle Name:ARNOLD
Last Name:SWEETBAUM
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12605 PENTENVILLE RD
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-3526
Mailing Address - Country:US
Mailing Address - Phone:301-622-2488
Mailing Address - Fax:301-622-1913
Practice Address - Street 1:10801 LOCKWOOD DR
Practice Address - Street 2:SUITE 165
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-1556
Practice Address - Country:US
Practice Address - Phone:301-681-6789
Practice Address - Fax:301-681-8122
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD325101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDA2100005OtherBLUE CROSS BLUE SHIELD
MDK554CO70-365125-02OtherMD BLUE CROSS BLUE SHIELD
MDR23878Medicare UPIN
MDK554CO70-365125-02OtherMD BLUE CROSS BLUE SHIELD