Provider Demographics
NPI:1699856245
Name:SWEET, JOHN F JR (EDD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:F
Last Name:SWEET
Suffix:JR
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15002 N 32ND ST
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-4441
Mailing Address - Country:US
Mailing Address - Phone:602-493-6150
Mailing Address - Fax:602-493-6155
Practice Address - Street 1:15002 N 32ND ST
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-4441
Practice Address - Country:US
Practice Address - Phone:602-493-6150
Practice Address - Fax:602-493-6155
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3547103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ082265Medicaid