Provider Demographics
NPI:1659699593
Name:SWEENEY, KATHLEEN (LICSW)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:SWEENEY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 CRAFTS ST
Mailing Address - Street 2:FIRST FLOOR
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02458-1249
Mailing Address - Country:US
Mailing Address - Phone:617-916-5069
Mailing Address - Fax:617-467-4073
Practice Address - Street 1:38 CRAFTS ST
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02458-1249
Practice Address - Country:US
Practice Address - Phone:617-916-5069
Practice Address - Fax:617-467-4073
Is Sole Proprietor?:No
Enumeration Date:2010-05-15
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1069961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MASWPO4451OtherINDIVIDUAL MEDICARE PART B PROVIDER NUMBER