Provider Demographics
NPI:1740471747
Name:SWEENEY, ANN MARIE (LIC AC)
Entity type:Individual
Prefix:
First Name:ANN MARIE
Middle Name:
Last Name:SWEENEY
Suffix:
Gender:F
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:416 NEWTONVILLE AVE
Mailing Address - Street 2:APARTMENT # 1
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02460-1932
Mailing Address - Country:US
Mailing Address - Phone:617-515-3268
Mailing Address - Fax:
Practice Address - Street 1:1330 BEACON ST
Practice Address - Street 2:SUITE # 223
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-3282
Practice Address - Country:US
Practice Address - Phone:617-515-3268
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2007-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA213804171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist