Provider Demographics
NPI:1417072331
Name:SWEENEY, PAMELA DENISE (MHHS, LSW)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:DENISE
Last Name:SWEENEY
Suffix:
Gender:F
Credentials:MHHS, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5112 CRANBERRY DR
Mailing Address - Street 2:
Mailing Address - City:MINERAL RIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:44440-9441
Mailing Address - Country:US
Mailing Address - Phone:330-505-9390
Mailing Address - Fax:
Practice Address - Street 1:5112 CRANBERRY DR
Practice Address - Street 2:
Practice Address - City:MINERAL RIDGE
Practice Address - State:OH
Practice Address - Zip Code:44440-9441
Practice Address - Country:US
Practice Address - Phone:330-505-9390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS-0025109101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor