Provider Demographics
NPI:1013927581
Name:SWEET FAATZ, ALICE E (ATR, LPC, LMHC)
Entity Type:Individual
Prefix:MS
First Name:ALICE
Middle Name:E
Last Name:SWEET FAATZ
Suffix:
Gender:F
Credentials:ATR, LPC, LMHC
Other - Prefix:MS
Other - First Name:ALICE
Other - Middle Name:E
Other - Last Name:SWEET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ATR, LPC
Mailing Address - Street 1:70 SOUTH ST
Mailing Address - Street 2:
Mailing Address - City:PORT BYRON
Mailing Address - State:NY
Mailing Address - Zip Code:13140-3203
Mailing Address - Country:US
Mailing Address - Phone:315-776-8780
Mailing Address - Fax:315-776-8780
Practice Address - Street 1:17 E GENESEE ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-4040
Practice Address - Country:US
Practice Address - Phone:315-253-9795
Practice Address - Fax:315-253-3255
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001990-1101YM0800X
TX10359101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional