Provider Demographics
NPI:1912950262
Name:SWEENEY, ELAINE MARY (PH D)
Entity Type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:MARY
Last Name:SWEENEY
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Gender:F
Credentials:PH D
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Mailing Address - Street 1:190 S QUINSIGAMOND AVE
Mailing Address - Street 2:UNIT 204
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545-4270
Mailing Address - Country:US
Mailing Address - Phone:508-842-2968
Mailing Address - Fax:508-842-2968
Practice Address - Street 1:298 BOSTON TPKE
Practice Address - Street 2:SUITE 10
Practice Address - City:SHREWSBURY
Practice Address - State:MA
Practice Address - Zip Code:01545-3871
Practice Address - Country:US
Practice Address - Phone:508-363-4332
Practice Address - Fax:508-842-2968
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA#7889103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA7889OtherMA PSYCHOLOGY LICENSE
MAWO6358OtherBCBSMA INDEMNITY PROVIDER