Provider Demographics
NPI:1891966198
Name:SWEENY, YADI F (PSYD)
Entity Type:Individual
Prefix:DR
First Name:YADI
Middle Name:F
Last Name:SWEENY
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 1:309 E 2ND ST
Mailing Address - Street 2:HPC 2ND FLOOR SUITE 2255 OR 2215
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91766-1854
Mailing Address - Country:US
Mailing Address - Phone:909-469-8332
Mailing Address - Fax:909-706-3780
Practice Address - Street 1:795 E 2ND ST
Practice Address - Street 2:SUITE 4
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91766-2007
Practice Address - Country:US
Practice Address - Phone:909-706-3779
Practice Address - Fax:909-620-1048
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-14
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY18095103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY 18095OtherCA CLINICAL PSY LICENSE
CAAV772UOtherMEDICARE SO. PTAN