Healthcare Provider Details

I. General information

NPI: 1982032447
Provider Name (Legal Business Name): TRACI-MARIE SWEET PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DR. TRACI-MARIE S KASPARIAN

II. Dates (important events)

Enumeration Date: 10/21/2013
Last Update Date: 03/21/2023
Certification Date: 07/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14704 ADINA LN
FORT MYERS FL
33905-5745
US

IV. Provider business mailing address

14704 ADINA LN
FORT MYERS FL
33905-5745
US

V. Phone/Fax

Practice location:
  • Phone: 508-579-0000
  • Fax:
Mailing address:
  • Phone: 508-579-0000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code175L00000X
TaxonomyHomeopath
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: