Provider Demographics
NPI:1770668469
Name:LEHNERT-SWEENEY, KIM LYNN (PHD)
Entity Type:Individual
Prefix:DR
First Name:KIM
Middle Name:LYNN
Last Name:LEHNERT-SWEENEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 BELLE MEAD RD
Mailing Address - Street 2:SUITE G
Mailing Address - City:EAST SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-6400
Mailing Address - Country:US
Mailing Address - Phone:631-328-5930
Mailing Address - Fax:631-675-1338
Practice Address - Street 1:140 BELLE MEAD RD
Practice Address - Street 2:SUITE G
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-6400
Practice Address - Country:US
Practice Address - Phone:631-328-5930
Practice Address - Fax:631-675-1338
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2009-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013596103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYVM3842Medicare ID - Type Unspecified