Provider Demographics
NPI:1376643288
Name:TIMOTHY J. SWEENEY, P.C.
Entity type:Organization
Organization Name:TIMOTHY J. SWEENEY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:SWEENEY
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:703-359-4848
Mailing Address - Street 1:11244 WAPLES MILL RD
Mailing Address - Street 2:SUITE K
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-6040
Mailing Address - Country:US
Mailing Address - Phone:703-359-4848
Mailing Address - Fax:703-991-9130
Practice Address - Street 1:11244 WAPLES MILL RD
Practice Address - Street 2:SUITE K
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-6040
Practice Address - Country:US
Practice Address - Phone:703-359-4848
Practice Address - Fax:703-991-9130
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCS276 0001OtherBLUECROSS BLUESHIELD
VA143965OtherBLUECROSS BLUESHIELD
DCS276 0001OtherBLUECROSS BLUESHIELD