Provider Demographics
NPI:1619478377
Name:SWEENY, LISA ANN (LMHC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ANN
Last Name:SWEENY
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7020 BISMARCK RD
Mailing Address - Street 2:
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32927-3920
Mailing Address - Country:US
Mailing Address - Phone:321-501-9081
Mailing Address - Fax:
Practice Address - Street 1:7020 BISMARCK RD
Practice Address - Street 2:
Practice Address - City:PORT SAINT JOHN
Practice Address - State:FL
Practice Address - Zip Code:32927-3920
Practice Address - Country:US
Practice Address - Phone:321-501-9081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-27
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH15756101YM0800X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health