Healthcare Provider Details

I. General information

NPI: 1629216940
Provider Name (Legal Business Name): KATHIE SWEETEN PSY.D., BCBA-D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2009
Last Update Date: 08/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11770 BERNARDO PLAZA CT 104
SAN DIEGO CA
92128-2422
US

IV. Provider business mailing address

11770 BERNARDO PLAZA CT 104
SAN DIEGO CA
92128-2422
US

V. Phone/Fax

Practice location:
  • Phone: 858-673-5300
  • Fax: 844-248-1549
Mailing address:
  • Phone: 858-673-5300
  • Fax: 844-248-1549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPSY 16494
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBCBA# 1-08-4657
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: