Provider Demographics
NPI:1932128444
Name:SWEETLAND, JOHN D (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:D
Last Name:SWEETLAND
Suffix:
Gender:M
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:PO BOX 496
Mailing Address - Street 2:53 HEWLETT AVE.
Mailing Address - City:POINT LOOKOUT
Mailing Address - State:NY
Mailing Address - Zip Code:11569-0496
Mailing Address - Country:US
Mailing Address - Phone:516-889-9190
Mailing Address - Fax:
Practice Address - Street 1:1400 WANTAGH AVE
Practice Address - Street 2:SUITE 212
Practice Address - City:WANTAGH
Practice Address - State:NY
Practice Address - Zip Code:11793-2257
Practice Address - Country:US
Practice Address - Phone:516-889-9190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006461103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0023096OtherGHI