Provider Demographics
NPI:1710135728
Name:SWEENER, KATHLEEN MANUPELLA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:MANUPELLA
Last Name:SWEENER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 HORIZON LN
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:NY
Mailing Address - Zip Code:12182-1663
Mailing Address - Country:US
Mailing Address - Phone:518-235-3701
Mailing Address - Fax:518-266-9236
Practice Address - Street 1:116 3RD ST
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NY
Practice Address - Zip Code:12180-4037
Practice Address - Country:US
Practice Address - Phone:518-235-3701
Practice Address - Fax:518-266-9236
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-03
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014350103T00000X, 103TA0400X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent