Provider Demographics
NPI:1629216940
Name:SWEETEN, KATHIE (PSYD, BCBA-D)
Entity Type:Individual
Prefix:DR
First Name:KATHIE
Middle Name:
Last Name:SWEETEN
Suffix:
Gender:F
Credentials:PSYD, BCBA-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11770 BERNARDO PLAZA CT
Mailing Address - Street 2:104
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-2422
Mailing Address - Country:US
Mailing Address - Phone:858-673-5300
Mailing Address - Fax:844-248-1549
Practice Address - Street 1:11770 BERNARDO PLAZA CT
Practice Address - Street 2:104
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-2422
Practice Address - Country:US
Practice Address - Phone:858-673-5300
Practice Address - Fax:844-248-1549
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-23
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CABCBA# 1-08-4657103K00000X
CAPSY 16494103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst