Provider Demographics
NPI:1659327476
Name:SWEENEY, TIMOTHY J (LCSW)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:J
Last Name:SWEENEY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11244 WAPLES MILL RD
Mailing Address - Street 2:SUITE K
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-6040
Mailing Address - Country:US
Mailing Address - Phone:703-359-4848
Mailing Address - Fax:703-991-9130
Practice Address - Street 1:11244 WAPLES MILL RD
Practice Address - Street 2:SUITE K
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-6040
Practice Address - Country:US
Practice Address - Phone:703-359-4848
Practice Address - Fax:703-991-9130
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2014-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040048121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC8495 0001OtherBLUECROSS BLUESHIELD
VA305829OtherBLUECROSS BLUESHIELD
353143OtherMHN
DCG02745T01Medicare PIN