Provider Demographics
NPI:1912948621
Name:SWEETWOOD, LORI ANN (PYSD)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:ANN
Last Name:SWEETWOOD
Suffix:
Gender:F
Credentials:PYSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 542
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07731-0542
Mailing Address - Country:US
Mailing Address - Phone:732-222-1100
Mailing Address - Fax:732-222-1103
Practice Address - Street 1:502 W FARMS RD
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:NJ
Practice Address - Zip Code:07731-1215
Practice Address - Country:US
Practice Address - Phone:732-222-1100
Practice Address - Fax:732-222-1103
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-10
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ3370103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ680008137OtherRR CARE
NJ6896901Medicaid
NJ680008137OtherRR CARE
NJ856540Medicare ID - Type Unspecified