Healthcare Provider Details

I. General information

NPI: 1659699593
Provider Name (Legal Business Name): KATHLEEN SWEENEY LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2010
Last Update Date: 08/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38 CRAFTS ST FIRST FLOOR
NEWTON MA
02458-1249
US

IV. Provider business mailing address

38 CRAFTS ST FIRST FLOOR
NEWTON MA
02458-1249
US

V. Phone/Fax

Practice location:
  • Phone: 617-916-5069
  • Fax: 617-467-4073
Mailing address:
  • Phone: 617-916-5069
  • Fax: 617-467-4073

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number106996
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
IdentifierSWPO4451
Identifier TypeOTHER
Identifier StateMA
Identifier IssuerINDIVIDUAL MEDICARE PART B PROVIDER NUMBER

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: