Provider Demographics
NPI:1013991900
Name:SWEITZER, ERIC KENYON (PHD)
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:KENYON
Last Name:SWEITZER
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 1:12 ALLISON RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02346-2635
Mailing Address - Country:US
Mailing Address - Phone:508-946-4921
Mailing Address - Fax:508-923-3462
Practice Address - Street 1:6 PLYMPTON ST
Practice Address - Street 2:
Practice Address - City:MIDDLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02346-1602
Practice Address - Country:US
Practice Address - Phone:508-947-1901
Practice Address - Fax:508-946-1615
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-03
Last Update Date:2021-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4550103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0520136Medicaid