Provider Demographics
NPI:1699828137
Name:SWEENEY, SHANNON (LMFT)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:SWEENEY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2524
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32772-2524
Mailing Address - Country:US
Mailing Address - Phone:407-330-0418
Mailing Address - Fax:407-321-0059
Practice Address - Street 1:204 N PARK AVE STE 100
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-1293
Practice Address - Country:US
Practice Address - Phone:407-330-0418
Practice Address - Fax:407-321-0059
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2020-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT1935106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist