Provider Demographics
NPI:1184170318
Name:SWEENEY, DWIGHT PAUL (PHD)
Entity type:Individual
Prefix:DR
First Name:DWIGHT
Middle Name:PAUL
Last Name:SWEENEY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:UNIVERSITY CENTER FOR DEVELOPMENTAL DISABILITIES
Mailing Address - Street 2:5500 UNIVERSITY PARKWAY
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92407-2318
Mailing Address - Country:US
Mailing Address - Phone:909-537-5495
Mailing Address - Fax:909-537-7002
Practice Address - Street 1:UNIVERSITY CENTER FOR DEVELOPMENTAL DISABILITIES
Practice Address - Street 2:5500 UNIVERSITY PARKWAY
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92407-2318
Practice Address - Country:US
Practice Address - Phone:909-537-5495
Practice Address - Fax:909-537-7002
Is Sole Proprietor?:No
Enumeration Date:2016-08-28
Last Update Date:2016-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAP70877172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker