Provider Demographics
NPI:1376735464
Name:SWEENEY, JOSEPH E (LPC/LADAC/SAP)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:E
Last Name:SWEENEY
Suffix:
Gender:M
Credentials:LPC/LADAC/SAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 190
Mailing Address - Street 2:
Mailing Address - City:VANDERWAGEN
Mailing Address - State:NM
Mailing Address - Zip Code:87326-0190
Mailing Address - Country:US
Mailing Address - Phone:505-778-5151
Mailing Address - Fax:505-778-5151
Practice Address - Street 1:103A SAGAR DRIVE
Practice Address - Street 2:
Practice Address - City:VANDERWAGEN
Practice Address - State:NM
Practice Address - Zip Code:87326
Practice Address - Country:US
Practice Address - Phone:505-778-5151
Practice Address - Fax:505-772-5151
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-13
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMT-0104081101YA0400X
NM0089971101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)