Provider Demographics
NPI:1770627408
Name:SWEENEY, CORNELIA M (PHD)
Entity type:Individual
Prefix:
First Name:CORNELIA
Middle Name:M
Last Name:SWEENEY
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:CONNIE
Other - Middle Name:M
Other - Last Name:SWEENEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:222 W GREGORY BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-1140
Mailing Address - Country:US
Mailing Address - Phone:816-361-0664
Mailing Address - Fax:816-361-0677
Practice Address - Street 1:222 W GREGORY BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-1140
Practice Address - Country:US
Practice Address - Phone:816-361-0664
Practice Address - Fax:816-361-0677
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-16
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOPY01634103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
20538019OtherBCBSKC INDIVIDUAL #
MO1770627408Medicaid
20538019OtherBCBSKC INDIVIDUAL #
R89150Medicare UPIN